Healthcare Provider Details

I. General information

NPI: 1619844883
Provider Name (Legal Business Name): EDEN BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41215 W ELM DR
MARICOPA AZ
85138-9504
US

IV. Provider business mailing address

41215 W ELM DR
MARICOPA AZ
85138-9504
US

V. Phone/Fax

Practice location:
  • Phone: 480-560-6351
  • Fax:
Mailing address:
  • Phone: 480-560-6351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: AWA NYAMUHINDU
Title or Position: MANAGING MEMBER
Credential:
Phone: 480-560-6351