Provider Demographics
NPI:1972578631
Name:EDEN CARE CENTER, INC
Entity type:Organization
Organization Name:EDEN CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TREBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-359-2000
Mailing Address - Street 1:PO BOX 155635
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-0635
Mailing Address - Country:US
Mailing Address - Phone:817-359-2000
Mailing Address - Fax:817-359-2093
Practice Address - Street 1:712 RAILROAD ST.
Practice Address - Street 2:DRAWER G
Practice Address - City:HICO
Practice Address - State:TX
Practice Address - Zip Code:76457
Practice Address - Country:US
Practice Address - Phone:254-796-2111
Practice Address - Fax:254-796-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-5468Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER