Provider Demographics
NPI:1912455825
Name:EDEN'S GARDEN ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:EDEN'S GARDEN ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-499-3522
Mailing Address - Street 1:1598 GILES ST NW
Mailing Address - Street 2:PRVT
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7077
Mailing Address - Country:US
Mailing Address - Phone:321-499-3522
Mailing Address - Fax:
Practice Address - Street 1:1598 GILES ST NW
Practice Address - Street 2:PRVT
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7077
Practice Address - Country:US
Practice Address - Phone:321-499-3522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility