Healthcare Provider Details

I. General information

NPI: 1952257248
Provider Name (Legal Business Name): EDEN WELLNESS HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 SAWGRASS CORPORATE PKWY STE 130
SUNRISE FL
33323-2860
US

IV. Provider business mailing address

1580 SAWGRASS CORPORATE PKWY STE 130
SUNRISE FL
33323-2860
US

V. Phone/Fax

Practice location:
  • Phone: 786-368-3039
  • Fax:
Mailing address:
  • Phone: 786-368-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MACKINSON ALEXIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-368-3039