Provider Demographics
NPI:1053876805
Name:EDEN SENIOR CARE SERVICES LLC
Entity type:Organization
Organization Name:EDEN SENIOR CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCARLETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:703-828-7545
Mailing Address - Street 1:6606 OKEEFE KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1864
Mailing Address - Country:US
Mailing Address - Phone:571-439-9005
Mailing Address - Fax:
Practice Address - Street 1:15120 ENTERPRISE CT STE 101
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1274
Practice Address - Country:US
Practice Address - Phone:240-377-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care