Healthcare Provider Details

I. General information

NPI: 1811785637
Provider Name (Legal Business Name): THE EDEN HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 FAIRFAX BLVD STE 500
FAIRFAX VA
22030-5017
US

IV. Provider business mailing address

7505 EQUINOX LANDING CT APT 204
GAINESVILLE VA
20155-4802
US

V. Phone/Fax

Practice location:
  • Phone: 571-992-7427
  • Fax:
Mailing address:
  • Phone: 571-992-7427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: GERTRUDE E EBENEZER
Title or Position: OWNER
Credential:
Phone: 571-992-7427