Provider Demographics
NPI:1457317034
Name:EDEN MEDICAL CENTER
Entity Type:Organization
Organization Name:EDEN MEDICAL CENTER
Other - Org Name:SAN LEANDRO HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYDUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-667-4511
Mailing Address - Street 1:P.O. BOX 60000, FILE 74500
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13855 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2611
Practice Address - Country:US
Practice Address - Phone:510-357-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000030282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC00264IMedicaid
CAZZR00264IMedicaid
CAZZZA0118ZOtherBLUE SHIELD
CAHSP40264IMedicaid
CA2082793OtherAETNA
CAZZZA0118ZOtherBLUE SHIELD