Provider Demographics
NPI:1154151744
Name:EDEN NURSING HOME SERVICE LLC
Entity type:Organization
Organization Name:EDEN NURSING HOME SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RAYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTES-ROLDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:787-516-8044
Mailing Address - Street 1:HC 5 BOX 56467
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9225
Mailing Address - Country:US
Mailing Address - Phone:787-526-6871
Mailing Address - Fax:
Practice Address - Street 1:M2 AVE LAUREL STE 3
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4662
Practice Address - Country:US
Practice Address - Phone:787-526-6871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care