Provider Demographics
NPI:1982265138
Name:EDEN MENTAL HEALTH CENTER CORP.
Entity Type:Organization
Organization Name:EDEN MENTAL HEALTH CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-208-9566
Mailing Address - Street 1:1840 W 49TH ST STE 605
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2962
Mailing Address - Country:US
Mailing Address - Phone:786-208-9566
Mailing Address - Fax:
Practice Address - Street 1:1840 W 49TH ST STE 605
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2962
Practice Address - Country:US
Practice Address - Phone:786-208-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health