Provider Demographics
NPI:1609540806
Name:THE GARDEN OF EDEN 2019 CORP
Entity Type:Organization
Organization Name:THE GARDEN OF EDEN 2019 CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAYDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-985-4601
Mailing Address - Street 1:4123 TAMIAMI TRAIL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112
Mailing Address - Country:US
Mailing Address - Phone:786-985-4601
Mailing Address - Fax:
Practice Address - Street 1:4123 TAMIAMI TRAIL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112
Practice Address - Country:US
Practice Address - Phone:786-985-4601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9506Medicaid