=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720778475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDENS GARDEN OF CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2023
-----------------------------------------------------
Last Update Date | 05/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9845 PINEAPPLE TREE DR APT 212
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33436-8070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-809-8344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9845 PINEAPPLE TREE DR APT 212
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33436-8070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-809-8344
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EDLINE JEAN BAPTISTE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-809-8344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD1600X
-----------------------------------------------------
Taxonomy Name | Developmental Disabilities Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------