Provider Demographics
NPI:1942190954
Name:EDEN HOMES & CARE SERVICES
Entity type:Organization
Organization Name:EDEN HOMES & CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSITED LIVING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MONGARE-RAPHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:ALDIR
Authorized Official - Phone:612-501-4445
Mailing Address - Street 1:18741 IVANHOE ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-5132
Mailing Address - Country:US
Mailing Address - Phone:612-438-7514
Mailing Address - Fax:763-267-7536
Practice Address - Street 1:18741 IVANHOE ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-5132
Practice Address - Country:US
Practice Address - Phone:612-438-7514
Practice Address - Fax:763-267-7536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility