Provider Demographics
NPI:1497200745
Name:EDEN HOME HEALTH OF ELK GROVE, LLC
Entity Type:Organization
Organization Name:EDEN HOME HEALTH OF ELK GROVE, LLC
Other - Org Name:EDEN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-892-6628
Mailing Address - Street 1:4601 NE 77TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6729
Mailing Address - Country:US
Mailing Address - Phone:360-892-6628
Mailing Address - Fax:360-882-5793
Practice Address - Street 1:9299 E STOCKTON BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4097
Practice Address - Country:US
Practice Address - Phone:916-681-4949
Practice Address - Fax:916-681-4888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPRES HOME HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-16
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058314Medicare Oscar/Certification