EDEN PRAIRIE RESIDENTIAL CARE SERVICES, LLC (NPI# 1215579537) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215579537 |
| Entity Type | Organization |
| Organization Name | EDEN PRAIRIE RESIDENTIAL CARE SERVICES, LLC |
| Practice Address |
302 Welch Blvd Flint MI 48503-1105 |
| Practice Telephone | 2142506576 |
| Practice Fax Number | 8103371546 |
| Mailing Telephone | 2142506576 |
| Mailing Fax Number | 8103371546 |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2019-10-09 |
| Authorized Official Name | MR. KEHINDE OLUGBOLAHAN OGUNDIPE (ADMINISTRATOR) |
| Authorized Official Telephone | 2142506576 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| Street Address |
302 WELCH BLVD |
| City | FLINT |
| State | MI |
| Zip Code | 48503-1105 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457971640 | Flint Odyssey House Inc. | Community/Behavioral Health | 1219 Martin Luther King Avenue, Flint, MI 48503 | 2020-04-17 |
| 1891265476 | Mary Margaret Woodruff | Health Educator | 411 E. Third St Suite 2, Flint, MI 48503 | 2018-11-27 |
| 1669942223 | Donna Jean Phelps | Behavior Technician | 2284 S Ballenger Highway, Flint, MI 48503 | 2018-11-27 |
| 1588150601 | Dayonna Scott | Social Worker | Hope Network, 2830 Corunna Rd, Flint, MI 48503 | 2018-07-02 |
| 1801388020 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 2284 S Ballenger Hwy Ste F, Flint, MI 48503 | 2018-06-04 |
| 1134610504 | Swathi Gorle | Student in an Organized Health Care Education/Training Program | Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503 | 2018-05-22 |
| 1881128049 | Kara Garr | Registered Nurse | 805 Tuuri Pl, Flint, MI 48503 | 2017-04-14 |
| 1518405638 | Thomasinia Terrell | Peer Specialist | 422 W Fourth Ave, Flint, MI 48503 | 2017-02-09 |
| 1790231041 | Roslyn Boyce | Technician, Other | 2213 E. Court Street, Flint, MI 48503 | 2016-08-28 |
| 1689120818 | Yasmine Elhefnawy | Student in an Organized Health Care Education/Training Program | One Hurley Plaza 3d West, Flint, MI 48503 | 2016-08-28 |
| Find all providers in zip 48503 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679010169 | Aim Too Please Home Care | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3220 Red Barn Rd, Flint, MI 48507-1278 | 2017-01-23 |
| 1477903730 | Gracie Hunter | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1110 Eldon Baker, Flint, MI 48507 | 2016-06-17 |
| 1770859217 | Consumer Advancement | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3209 Old Farm Rd, 4438 Colby Ct., Flint, MI 48507-1248 | 2012-03-29 |
| 1164718441 | Alternative Community Living, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 304 W Tobias St, Flint, MI 48503-3975 | 2011-06-24 |
| 1255576765 | Deshra Michelle Vines | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 714 Lippincott Blvd, Flint, MI 48503-5818 | 2008-12-11 |
| 1598916793 | Royster Haven | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2026 Oren Ave, Flint, MI 48505-4688 | 2008-10-06 |
| 1275740441 | Alternative Community Living, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1921 Colchester Rd, Flint, MI 48503-4676 | 2007-05-17 |
| 1609083872 | Alternative Community Living, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2820 Westwood Pkwy, Flint, MI 48503-4671 | 2007-05-17 |
| 1003842444 | Mayfield Adult Foster Care Home, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1113 E Hemphill Rd, Flint, MI 48507-2835 | 2006-06-25 |
| 1316973530 | Coldwater Place | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4318 E Coldwater Rd, Flint, MI 48506-1054 | 2006-06-23 |
| Find all providers in FLINT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.