Provider Demographics
NPI:1700590411
Name:EDEN HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:EDEN HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONI
Authorized Official - Middle Name:I
Authorized Official - Last Name:BOLARIN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:317-331-3827
Mailing Address - Street 1:450 E 96TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3760
Mailing Address - Country:US
Mailing Address - Phone:317-331-3827
Mailing Address - Fax:
Practice Address - Street 1:450 E 96TH ST STE 500
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3760
Practice Address - Country:US
Practice Address - Phone:317-331-3827
Practice Address - Fax:866-712-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health