Provider Demographics
NPI:1184372625
Name:EDEN AUTISM SERVICES
Entity type:Organization
Organization Name:EDEN AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. DIRECTOR OF MEDICAID & EHR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-608-8531
Mailing Address - Street 1:2 MERRICK ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5730
Mailing Address - Country:US
Mailing Address - Phone:609-987-0099
Mailing Address - Fax:609-987-0243
Practice Address - Street 1:313 OAK LN
Practice Address - Street 2:
Practice Address - City:WEST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08550-3611
Practice Address - Country:US
Practice Address - Phone:609-987-0099
Practice Address - Fax:609-987-0243
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDEN AUTISM SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-14
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0476536Medicaid