Organization
EDEN'S PROMISE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIVEN DENISE BANKS (OWNER)
(561) 201-2915
Entity
Organization
Contact information
Practice address
1149 SW ESTAUGH AVE, PORT SAINT LUCIE, FL 34953-1810
(561) 201-2915
Mailing address
1149 SW ESTAUGH AVE, PORT SAINT LUCIE, FL 34953-1810
(561) 201-2915
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
12/25/2021
Last updated
01/03/2022
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