Provider Demographics
NPI:1023551264
Name:EDEN CARE CENTER
Entity Type:Organization
Organization Name:EDEN CARE CENTER
Other - Org Name:EDEN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRAOR/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-588-3337
Mailing Address - Street 1:4943 SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3020
Mailing Address - Country:US
Mailing Address - Phone:323-588-3337
Mailing Address - Fax:323-588-3336
Practice Address - Street 1:4943 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3020
Practice Address - Country:US
Practice Address - Phone:323-588-3337
Practice Address - Fax:323-588-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5500037093140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN