Provider Demographics
NPI:1952011637
Name:HOUSE OF EDEN RESIDENTIAL CARE
Entity Type:Organization
Organization Name:HOUSE OF EDEN RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:539-867-1531
Mailing Address - Street 1:3604 N MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-6447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3604 N MLK JR BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-6447
Practice Address - Country:US
Practice Address - Phone:539-867-1531
Practice Address - Fax:539-867-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care