MEDICARE: EDEN HOME HEALTH, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1043658602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN HOME HEALTH, INC

Provider Business Mailing Address
First Line	:	6300 CANOGA AVE STE 1310
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-8003
Country	:	US
Telephone Number	:	818-324-0728
Fax Number	:	818-704-1454

Provider Business Practice Location Address
First Line	:	6300 CANOGA AVE STE 1310
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-8003
Country	:	US
Telephone Number	:	818-324-0728
Fax Number	:	818-704-1454

Authorized Official
Title or Position	:	CEO
Name	:	MORRIS OHEV SHALOM
Credential	:	RN
Telephone Number	:	818-324-0728

Provider Enumeration Date	:	06/05/2013
Last Update Date	:	10/23/2023

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