Healthcare Provider Details

I. General information

NPI: 1548520992
Provider Name (Legal Business Name): OPIES OF EDEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2012
Last Update Date: 05/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MEADOW RD 102
EDEN NC
27288-3464
US

IV. Provider business mailing address

201 E MEADOW RD 102
EDEN NC
27288-3464
US

V. Phone/Fax

Practice location:
  • Phone: 336-342-3135
  • Fax:
Mailing address:
  • Phone: 336-342-3135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNC

VIII. Authorized Official

Name: WENDY PAUL
Title or Position: DIRECTOR
Credential:
Phone: 336-342-3135