Provider Demographics
NPI:1053049437
Name:EDEN ADULT DAY CARE, INC
Entity type:Organization
Organization Name:EDEN ADULT DAY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YONGRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKBAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-662-9322
Mailing Address - Street 1:4525 162ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3279
Mailing Address - Country:US
Mailing Address - Phone:516-662-9322
Mailing Address - Fax:
Practice Address - Street 1:4525 162ND ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3279
Practice Address - Country:US
Practice Address - Phone:516-662-9322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care