Provider Demographics
NPI:1417146812
Name:EDEN OCP
Entity Type:Organization
Organization Name:EDEN OCP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GIZELLE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:LETOURNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-939-3541
Mailing Address - Street 1:301 PINE ST
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-3305
Mailing Address - Country:US
Mailing Address - Phone:406-939-3541
Mailing Address - Fax:800-460-9219
Practice Address - Street 1:301 PINE ST
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-3305
Practice Address - Country:US
Practice Address - Phone:406-939-3541
Practice Address - Fax:800-460-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies