Provider Demographics
NPI:1457027526
Name:THE EDEN CENTER FOR INTEGRATIVE CARE
Entity Type:Organization
Organization Name:THE EDEN CENTER FOR INTEGRATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-791-2856
Mailing Address - Street 1:84 BROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4381
Mailing Address - Country:US
Mailing Address - Phone:518-636-5284
Mailing Address - Fax:
Practice Address - Street 1:84 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4386
Practice Address - Country:US
Practice Address - Phone:518-636-5284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty