Provider Demographics
NPI:1811276090
Name:THE EDEN INN ALF
Entity type:Organization
Organization Name:THE EDEN INN ALF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SULAIMAN
Authorized Official - Middle Name:PEERU
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-581-2240
Mailing Address - Street 1:4064 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33314-5712
Mailing Address - Country:US
Mailing Address - Phone:954-581-2240
Mailing Address - Fax:954-581-2240
Practice Address - Street 1:4064 SW 51ST ST
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33314-5712
Practice Address - Country:US
Practice Address - Phone:954-581-2240
Practice Address - Fax:954-581-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10495310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility