MEDICARE: EDEN'S WAY, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1740829829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN'S WAY, LLC

Provider Business Mailing Address
First Line	:	6861 W CHARLESTON BLVD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1667
Country	:	US
Telephone Number	:	725-255-8002
Fax Number	:

Provider Business Practice Location Address
First Line	:	6861 W CHARLESTON BLVD STE A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1667
Country	:	US
Telephone Number	:	725-255-8002
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	BRITNEY VAUGHN
Credential	:
Telephone Number	:	725-255-8002

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	04/16/2024

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