Provider Demographics
NPI:1962828319
Name:EDEN HILL EXPRESSCARE, LLC
Entity Type:Organization
Organization Name:EDEN HILL EXPRESSCARE, LLC
Other - Org Name:EXPRESSCARE OF BEAR, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-420-6970
Mailing Address - Street 1:1505 E CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4742
Mailing Address - Country:US
Mailing Address - Phone:410-420-6970
Mailing Address - Fax:410-420-6967
Practice Address - Street 1:1011 E SONGSMITH DRIVE
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1194
Practice Address - Country:US
Practice Address - Phone:302-918-7501
Practice Address - Fax:308-918-7331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10009686261QU0200X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE140374Medicare PIN