Provider Demographics
NPI:1114338258
Name:EDEN CARE HOMES, LLC
Entity Type:Organization
Organization Name:EDEN CARE HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-848-8378
Mailing Address - Street 1:7845 N ROBINSON AVE
Mailing Address - Street 2:SUITE H3
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7739
Mailing Address - Country:US
Mailing Address - Phone:405-848-8378
Mailing Address - Fax:405-848-8311
Practice Address - Street 1:7845 N ROBINSON AVE
Practice Address - Street 2:SUITE H3
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7739
Practice Address - Country:US
Practice Address - Phone:405-848-8378
Practice Address - Fax:405-848-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility