NPIMap

Organization Active NPI

Eden's Promise

  • Developmental Disabilities Clinic/Center
  • Port Saint Lucie, FL
National Provider Identifier
1932869476
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
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
Last updated
Jan 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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

Authorized official

Name
Viven Denise BanksNPI 1164911301
Title
Owner
Phone
(561) 201-2915

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X Primary

Addresses

Primary practice location

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

Mailing address

1149 SW Estaugh Ave
Port Saint Lucie, FL 34953-1810
Phone (561) 201-2915

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": []
}

Other providers in Port Saint Lucie, FL

Sources for this page

  • 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.