MEDICARE: EDEN HOME CARE SERVICES 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	2015L001	NY

General Provider Information

NPI Number	:	1760873103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN HOME CARE SERVICES INC

Provider Business Mailing Address
First Line	:	353 LINWOOD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2117
Country	:	US
Telephone Number	:	718-355-9755
Fax Number	:	718-355-9756

Provider Business Practice Location Address
First Line	:	353 LINWOOD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2117
Country	:	US
Telephone Number	:	718-355-9755
Fax Number	:	718-355-9756

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WAYNE D PETERS
Credential	:
Telephone Number	:	718-355-9755

Provider Enumeration Date	:	02/06/2015
Last Update Date	:	02/06/2015

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