Provider Demographics
NPI:1295405884
Name:EDEN BY ENHANCE LLC
Entity Type:Organization
Organization Name:EDEN BY ENHANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:833-903-3334
Mailing Address - Street 1:35 MANN ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2741
Mailing Address - Country:US
Mailing Address - Phone:833-903-3334
Mailing Address - Fax:
Practice Address - Street 1:35 MANN ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2741
Practice Address - Country:US
Practice Address - Phone:833-903-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility