Provider Demographics
NPI:1477005635
Name:EDEN AUTISM
Entity Type:Organization
Organization Name:EDEN AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EHR TRAINER/MEDICAID SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-987-0099
Mailing Address - Street 1:2 MERWICK RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5730
Mailing Address - Country:US
Mailing Address - Phone:609-987-0099
Mailing Address - Fax:
Practice Address - Street 1:14 VAHLSING WAY
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1117
Practice Address - Country:US
Practice Address - Phone:609-223-3943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities