Active Seniors Consulting Dba the Eden Inn

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

ACTIVE SENIORS CONSULTING DBA THE EDEN INN

Practice address

4064 SW 51St St
Fort Lauderdale, FL 33314-5712

Phone

(954) 581-2240

Fax

(954) 581-2240

NPI assigned

Apr 29, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Sherlyn Greene

Title

President

Phone

(954) 347-7495

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• The Eden Inn Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1104447267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4064 SW 51ST ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333145712",
            "telephone_number": "954-581-2240",
            "fax_number": "954-581-2240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4064 SW 51ST ST",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333145712",
            "telephone_number": "954-581-2240",
            "fax_number": "954-581-2240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE SENIORS CONSULTING DBA THE EDEN INN",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-29",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "GREENE",
        "authorized_official_first_name": "SHERLYN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-347-7495",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9545812240",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASSISTANCE  LIVING",
            "identifier": "NONE",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Eden Inn",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.