Provider Demographics
NPI:1831260165
Name:EDEN HEALTH CARE SERVICES INCORPORATED
Entity type:Organization
Organization Name:EDEN HEALTH CARE SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MURPHY
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-7719
Mailing Address - Street 1:178 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-7532
Mailing Address - Country:US
Mailing Address - Phone:910-739-7719
Mailing Address - Fax:910-628-7550
Practice Address - Street 1:528 JOHN HENRY LEE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-9159
Practice Address - Country:US
Practice Address - Phone:910-272-0162
Practice Address - Fax:910-272-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-184320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805633Medicaid