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General NPI Number Information
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NPI Number | 1134122179
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Entity Type | Organization
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Legal Business Name | EDEN MEDICAL CENTER
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 20103 LAKE CHABOT RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5305
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Country | US
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Telephone | 510-537-1234
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Fax | 510-889-6506
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Provider Business Mailing Address
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Address Line | PO BOX 748373
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City | LOS ANGELES
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State | CA
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Zip | 90074-8373
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Country | US
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Telephone | 855-398-1633
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Fax | 510-869-6592
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Authorized Official
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Title or Position | VP SHARED SERVICES
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Name | MR. BRIAN TRENT HUNTER
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Credential |
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Telephone | 916-297-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 140000030
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License Number State | CA
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