Provider Demographics
NPI:1649778622
Name:EDEN AUTISM SERVICES
Entity Type:Organization
Organization Name:EDEN AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EHR/MEDICAID MANAGER
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:609-608-8531
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:609-987-0243
Practice Address - Street 1:12 SCHENK PL
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1146
Practice Address - Country:US
Practice Address - Phone:609-987-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDEN AUTISM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities