Provider Demographics
NPI:1215188537
Name:EDEN INSTITUTE
Entity Type:Organization
Organization Name:EDEN INSTITUTE
Other - Org Name:EDEN FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GALELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-992-4680
Mailing Address - Street 1:24860 BURNT PINE DR
Mailing Address - Street 2:BUILDING 6, SUITE 3
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-1909
Mailing Address - Country:US
Mailing Address - Phone:239-992-4680
Mailing Address - Fax:239-992-4952
Practice Address - Street 1:24860 BURNT PINE DR
Practice Address - Street 2:BUILDING 6, SUITE 3
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-1909
Practice Address - Country:US
Practice Address - Phone:239-992-4680
Practice Address - Fax:239-992-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL682652196Medicaid