Healthcare Provider Details

I. General information

NPI: 1194647461
Provider Name (Legal Business Name): EDEN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 S UNIVERSITY BLVD
GREENWOOD VILLAGE CO
80121-2866
US

IV. Provider business mailing address

5990 S UNIVERSITY BLVD
GREENWOOD VILLAGE CO
80121-2866
US

V. Phone/Fax

Practice location:
  • Phone: 720-605-7678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATT BANDELIER
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 303-257-9181