Provider Demographics
NPI:1962702647
Name:EDEN REHAB AND SPA INC
Entity type:Organization
Organization Name:EDEN REHAB AND SPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:YENISLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-443-2201
Mailing Address - Street 1:1 GLEN ROYAL PKWY
Mailing Address - Street 2:301
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5287
Mailing Address - Country:US
Mailing Address - Phone:786-443-2201
Mailing Address - Fax:
Practice Address - Street 1:1 GLEN ROYAL PKWY
Practice Address - Street 2:301
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5287
Practice Address - Country:US
Practice Address - Phone:786-443-2201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty