Healthcare Provider Details

I. General information

NPI: 1447149844
Provider Name (Legal Business Name): EDEN SPRINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 W ANGELA DR
PHOENIX AZ
85053-1916
US

IV. Provider business mailing address

3002 W ANGELA DR
PHOENIX AZ
85053-1916
US

V. Phone/Fax

Practice location:
  • Phone: 602-538-8697
  • Fax:
Mailing address:
  • Phone: 602-538-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SEFORA DRAGAN
Title or Position: OWNER
Credential: BSN, RN
Phone: 602-538-8697