Provider Demographics
NPI:1073155875
Name:EDENCARE HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:EDENCARE HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MWESIGWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-202-0875
Mailing Address - Street 1:729 1ST ST STE D
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1303
Mailing Address - Country:US
Mailing Address - Phone:925-202-0875
Mailing Address - Fax:925-481-3820
Practice Address - Street 1:729 1ST ST STE D
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1303
Practice Address - Country:US
Practice Address - Phone:612-598-6078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-13
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health