Healthcare Provider Details

I. General information

NPI: 1952673014
Provider Name (Legal Business Name): EDEN HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2638 HIGHWAY 109 STE. 100
WILDWOOD MO
63040-1182
US

IV. Provider business mailing address

2638 HIGHWAY 109 STE. 100
WILDWOOD MO
63040-1182
US

V. Phone/Fax

Practice location:
  • Phone: 636-493-6027
  • Fax: 636-452-7689
Mailing address:
  • Phone: 636-493-6027
  • Fax: 636-493-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: EDMOND J MEYER
Title or Position: MANAGING MEMBER / CEO
Credential: RN, BSN, AE-C
Phone: 314-401-8844