Provider Demographics
NPI:1548536006
Name:EDEN MEDICAL CENTER
Entity type:Organization
Organization Name:EDEN MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BISCHALANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-727-2703
Mailing Address - Street 1:20103 LAKE CHABOT RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5305
Mailing Address - Country:US
Mailing Address - Phone:510-537-1234
Mailing Address - Fax:510-889-6506
Practice Address - Street 1:13855 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2611
Practice Address - Country:US
Practice Address - Phone:510-357-6500
Practice Address - Fax:510-667-4572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP40264IMedicaid
CAHSC00264IMedicaid
CAZZR00264IMedicaid
CA2082793OtherAETNA
CAZZZ0118ZOtherBLUE SHIELD
CAHSC00264IMedicaid