Provider Demographics
NPI:1003162447
Name:EDEN NATURAL HEALING INSTITUTE, LLC
Entity Type:Organization
Organization Name:EDEN NATURAL HEALING INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-996-0888
Mailing Address - Street 1:20370 TOWN CENTER LN STE B202
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3213
Mailing Address - Country:US
Mailing Address - Phone:408-996-0888
Mailing Address - Fax:408-973-9874
Practice Address - Street 1:20370 TOWN CENTER LN STE B202
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3213
Practice Address - Country:US
Practice Address - Phone:408-996-0888
Practice Address - Fax:408-973-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10610302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization