Healthcare Provider Details

I. General information

NPI: 1114841707
Provider Name (Legal Business Name): EDEN RISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PHILLIPS AVE STE L104
SIOUX FALLS SD
57104-6059
US

IV. Provider business mailing address

200 N PHILLIPS AVE STE L104
SIOUX FALLS SD
57104-6059
US

V. Phone/Fax

Practice location:
  • Phone: 605-275-0097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: INNOCENT YAGABO
Title or Position: PRESIDENT
Credential:
Phone: 605-275-0097