Healthcare Provider Details

I. General information

NPI: 1205350105
Provider Name (Legal Business Name): EDEN CARE FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7009 S POTOMAC ST # 108
CENTENNIAL CO
80112-4037
US

IV. Provider business mailing address

2021 S HANNIBAL WAY APT B
AURORA CO
80013-4068
US

V. Phone/Fax

Practice location:
  • Phone: 720-594-8163
  • Fax: 720-222-6269
Mailing address:
  • Phone: 720-812-2009
  • Fax: 720-222-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GINNY LYNN BLALOCK
Title or Position: COO/ EXECUTIVE DIRECTOR
Credential:
Phone: 720-812-2009