Provider Demographics
NPI:1508210089
Name:GARDEN OF EDEN HOME CARE LLC
Entity Type:Organization
Organization Name:GARDEN OF EDEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-680-2865
Mailing Address - Street 1:2626 TUSCAN HILLS LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1809
Mailing Address - Country:US
Mailing Address - Phone:575-680-2865
Mailing Address - Fax:575-680-2865
Practice Address - Street 1:2626 TUSCAN HILLS LN
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1809
Practice Address - Country:US
Practice Address - Phone:575-680-2865
Practice Address - Fax:575-680-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM14851253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care