Provider Demographics
NPI:1356000467
Name:CENTRO EDEN HEALTH CARE, INC.
Entity Type:Organization
Organization Name:CENTRO EDEN HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PREMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-798-1900
Mailing Address - Street 1:11 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2213
Mailing Address - Country:US
Mailing Address - Phone:085-798-1900
Mailing Address - Fax:508-798-1914
Practice Address - Street 1:11 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2213
Practice Address - Country:US
Practice Address - Phone:085-798-1900
Practice Address - Fax:508-798-1914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO LAS AMERICAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization