MEDICARE: FREDS EDEN PARK CARING HOMES LLC

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	:	1396611109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDS EDEN PARK CARING HOMES LLC

Provider Business Mailing Address
First Line	:	1038 MADISON LN
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-5016
Country	:	US
Telephone Number	:	701-989-8981
Fax Number	:

Provider Business Practice Location Address
First Line	:	1038 MADISON LN
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-5016
Country	:	US
Telephone Number	:	701-989-8981
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FREDDY GASOMORA
Credential	:
Telephone Number	:	701-989-8981

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	10/17/2025

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