Provider Demographics
NPI:1902410087
Name:BEAUTIFUL EDEN LLC
Entity Type:Organization
Organization Name:BEAUTIFUL EDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UDEME
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:UDOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-886-2255
Mailing Address - Street 1:3410 CABERNET SHORES DR
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1918
Mailing Address - Country:US
Mailing Address - Phone:281-886-2255
Mailing Address - Fax:
Practice Address - Street 1:3410 CABERNET SHORES DR
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-1918
Practice Address - Country:US
Practice Address - Phone:281-886-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care