=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023551264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDEN CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2016
-----------------------------------------------------
Last Update Date | 06/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4943 SLAUSON AVE
-----------------------------------------------------
City | MAYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90270-3020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-588-3337
-----------------------------------------------------
Fax | 323-588-3336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4943 SLAUSON AVE
-----------------------------------------------------
City | MAYWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90270-3020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-588-3337
-----------------------------------------------------
Fax | 323-588-3336
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRAOR/CEO
-----------------------------------------------------
Name | MISS ELINA FOGEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-588-3337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3140N1450X
-----------------------------------------------------
Taxonomy Name | Pediatric Skilled Nursing Facility
-----------------------------------------------------
License Number | 550003709
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------