NPIMap

Organization Active NPI

Eden Park Health Services, Inc

  • Assisted Living Facility
  • Troy, NY
National Provider Identifier
1891865432
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
600-F-246 Issued in NY
Legal business name
EDEN PARK HEALTH SERVICES, INC
Practice address
2405 15TH St
Troy, NY 12180-1702
Phone
(518) 266-9654
NPI assigned
Nov 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert Glock
Title
President
Phone
(518) 436-4731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 600-F-246 NY Primary

Addresses

Primary practice location

2405 15TH St
Troy, NY 12180-1702

Mailing address

22 Holland Ave
Albany, NY 12209-1713
Phone (518) 436-4731

Other identifiers 1

IdentifierTypeStateIssuer
06066571MedicaidNY

Other names 1

  • Eden Park Health Services, Inc. ALP Other name

National Provider Directory

National Provider Directory
Tax ID family
Eden Park Health Care Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2405 15th St
Troy, NY 12180
Phone (518) 266-9654

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891865432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 HOLLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122091713",
            "telephone_number": "518-436-4731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 15TH ST",
            "city": "TROY",
            "state": "NY",
            "postal_code": "121801702",
            "telephone_number": "518-266-9654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN PARK HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GLOCK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-436-4731"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NY",
            "license": "600-F-246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06066571",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eden Park Health Services, Inc. ALP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Troy, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.