Eden'S Promise

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

EDEN'S PROMISE

Practice address

1149 SW Estaugh Ave
Port Saint Lucie, FL 34953-1810

Phone

(561) 201-2915

NPI assigned

Dec 25, 2021

Organization subpart

No

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

Authorized official

Name

Viven Denise Banks

Title

Owner

Phone

(561) 201-2915

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1640390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641168000000",
    "number": "1932869476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1149 SW ESTAUGH AVE",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349531810",
            "telephone_number": "561-201-2915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 SW ESTAUGH AVE",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349531810",
            "telephone_number": "561-201-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN'S PROMISE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-25",
        "last_updated": "2022-01-03",
        "certification_date": "2022-01-03",
        "status": "A",
        "authorized_official_last_name": "BANKS",
        "authorized_official_first_name": "VIVEN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-201-2915"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Lynn East, APRN
• Blair Marie East, APRN
• Angela Easterling
• Amy Ebersole
• Echelon Premium Health LLC
• Michelle Edmond, LCSW
• Lauren Elizabeth Edrington
• Eduardo Borges, MD, PA
• Shannon Margaret Edwards
• Katie Anne Morris Eisnaugle, FNP-C, PMHNP-BC

• Developmental Disabilities Clinic/Center in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.