Healthcare Provider Details

I. General information

NPI: 1205527439
Provider Name (Legal Business Name): DR. EDEN HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 FENTON ST STE 203
SILVER SPRING MD
20910-6701
US

IV. Provider business mailing address

9002 PENNSYLVANIA AVE
SILVER SPRING MD
20910-1914
US

V. Phone/Fax

Practice location:
  • Phone: 301-318-1859
  • Fax:
Mailing address:
  • Phone: 301-318-1859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. EDEN MULUNEH TAYE
Title or Position: CEO
Credential: DNP
Phone: 301-318-1859