Provider Demographics
NPI:1821656703
Name:GARDEN OF EDEN HEALTH CENTER CORP
Entity Type:Organization
Organization Name:GARDEN OF EDEN HEALTH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-414-5511
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-0553
Mailing Address - Country:US
Mailing Address - Phone:939-403-4226
Mailing Address - Fax:
Practice Address - Street 1:BO MAMEYES ARRIBA SECTOR VISTA ALEGRE
Practice Address - Street 2:CARR 141 KM 13.1
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:939-403-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service