Provider Demographics
NPI:1053017376
Name:EDEN HEALTH MD
Entity type:Organization
Organization Name:EDEN HEALTH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SIMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:443-202-0637
Mailing Address - Street 1:2 CASTLEBAR CT
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1924
Mailing Address - Country:US
Mailing Address - Phone:443-202-0637
Mailing Address - Fax:
Practice Address - Street 1:54 SCOTT ADAM RD STE 106
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3351
Practice Address - Country:US
Practice Address - Phone:443-202-0637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty