Provider Demographics
NPI:1720225170
Name:EDEN HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:EDEN HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WOO
Authorized Official - Middle Name:SUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-679-2700
Mailing Address - Street 1:7300 N CICERO AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1641
Mailing Address - Country:US
Mailing Address - Phone:847-679-2700
Mailing Address - Fax:847-679-2703
Practice Address - Street 1:7300 N CICERO AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1641
Practice Address - Country:US
Practice Address - Phone:847-679-2700
Practice Address - Fax:847-679-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health