Provider Demographics
NPI:1689130833
Name:EDEN HOME CARE LLC
Entity Type:Organization
Organization Name:EDEN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HYE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCARLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-377-6760
Mailing Address - Street 1:15120 ENTERPRISE CT STE 101
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1274
Mailing Address - Country:US
Mailing Address - Phone:240-377-6760
Mailing Address - Fax:
Practice Address - Street 1:15120 ENTERPRISE CT STE 101
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1274
Practice Address - Country:US
Practice Address - Phone:249-377-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-2054OtherVIRGINIA HOME CARE LICENSE