Provider Demographics
NPI:1245738707
Name:EDEN STAR LIVING LLC
Entity Type:Organization
Organization Name:EDEN STAR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:ADENIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-365-4942
Mailing Address - Street 1:13250 WESTHEIMER RD APT 202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3586
Mailing Address - Country:US
Mailing Address - Phone:720-365-4942
Mailing Address - Fax:
Practice Address - Street 1:13250 WESTHEIMER RD APT 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3586
Practice Address - Country:US
Practice Address - Phone:720-365-4942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child