Eden Prairie Residential Care Services, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

EDEN PRAIRIE RESIDENTIAL CARE SERVICES, LLC

Practice address

302 Welch Blvd
Flint, MI 48503-1105

Phone

(214) 250-6576

Fax

(810) 337-1546

NPI assigned

Oct 9, 2019

Last updated

Oct 9, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kehinde Olugbolahan Ogundipe

Title

Administrator

Phone

(214) 250-6576

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1215579537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 WELCH BLVD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485031105",
            "telephone_number": "214-250-6576",
            "fax_number": "810-337-1546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 WELCH BLVD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485031105",
            "telephone_number": "214-250-6576",
            "fax_number": "810-337-1546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN PRAIRIE RESIDENTIAL CARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-09",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "OGUNDIPE",
        "authorized_official_first_name": "KEHINDE",
        "authorized_official_middle_name": "OLUGBOLAHAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "214-250-6576",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nnenna Nwanyiriuba Eboda, BDS
• Shayhana Ebrahim, DMD
• Cindy Eckert
• Melvin Victor Eckles
• Idara John Edem, MD, MSC, FRCPC
• Sarah Edgerton
• Ashiya Edmond, BA, QMHP, QIDP
• Robert Keith Edmonds
• Edward Gomez-Seoane MD & Silvia Gomez-Seoane MD PC
• Edward J Conley DO PC (Fatigue & Fibromyalgia Clinic Of Michigan)

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Flint, MI
• Providers in Flint, MI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; 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.