Provider Demographics
NPI:1245431089
Name:EDEN TERRACE
Entity Type:Organization
Organization Name:EDEN TERRACE
Other - Org Name:SUNRISE SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:817-457-9710
Mailing Address - Street 1:2500 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-1367
Mailing Address - Country:US
Mailing Address - Phone:817-457-9710
Mailing Address - Fax:817-492-4330
Practice Address - Street 1:2500 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-1367
Practice Address - Country:US
Practice Address - Phone:817-457-9710
Practice Address - Fax:817-492-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100100310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)