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General NPI Number Information
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NPI Number | 1053876805
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Entity Type | Organization
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Legal Business Name | EDEN SENIOR CARE SERVICES LLC
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 15120 ENTERPRISE CT STE 101
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City | CHANTILLY
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State | VA
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Zip | 20151-1274
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Country | US
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Telephone | 240-377-6760
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Fax |
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Provider Business Mailing Address
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Address Line | 6606 OKEEFE KNOLL CT
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City | FAIRFAX STATION
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State | VA
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Zip | 22039-1864
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Country | US
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Telephone | 571-439-9005
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ISABEL H SCARLETT JR.
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Credential |
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Telephone | 703-828-7545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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