Provider Demographics
NPI:1780276162
Name:EDENS PLACE LLC
Entity type:Organization
Organization Name:EDENS PLACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-849-2925
Mailing Address - Street 1:4111 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35208-1807
Mailing Address - Country:US
Mailing Address - Phone:803-849-2925
Mailing Address - Fax:
Practice Address - Street 1:4111 AVENUE L
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208-1807
Practice Address - Country:US
Practice Address - Phone:803-849-2925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty