# EDENMD WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801513114
- **Authorized official:** DR. RUTH FORDE MD (PHYSICIAN, PARTNER, ADMINISTRATOR)
- **Authorized official phone:** (956) 607-4880

## Contact information

- **Practice address:** 7760 E STATE ROUTE 69 STE C5-342, PRESCOTT VALLEY, AZ 86314-2201
- **Practice address phone:** (602) 525-8530
- **Mailing address:** 6620 E DESPERADO DR, PRESCOTT VALLEY, AZ 86314-5824
- **Mailing address phone:** (956) 607-4880

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/26/2022
- **Last updated:** 11/07/2022