Provider Demographics
NPI:1043888498
Name:EDEN HOMECARE LLC
Entity Type:Organization
Organization Name:EDEN HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:KAKRA
Authorized Official - Last Name:EFFRAIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-466-3154
Mailing Address - Street 1:4468 EDGEMONT DR SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4216
Mailing Address - Country:US
Mailing Address - Phone:616-466-3154
Mailing Address - Fax:
Practice Address - Street 1:4468 EDGEMONT DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4216
Practice Address - Country:US
Practice Address - Phone:616-466-3154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-13
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care