Organization
JACKSON ODONDI
Active
Other names
Eden Spring Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACKSON ODONDI (ADMINISTRATOR)
(919) 949-3585
Entity
Organization
Contact information
Practice address
3812 BOOKER AVE, DURHAM, NC 27713-1126
(919) 544-0874
(919) 544-0874
Mailing address
PO BOX 15927, DURHAM, NC 27704-0927
(919) 544-0874
(919) 544-5331
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
HAL-032-073
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805238
—
NC
Enumeration date
02/14/2007
Last updated
07/02/2008
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