Healthcare Provider Details

I. General information

NPI: 1447982137
Provider Name (Legal Business Name): EDEN TREATMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 06/30/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 LONE MESA DR
LAS VEGAS NV
89147-6814
US

IV. Provider business mailing address

8225 W ROBINDALE RD
LAS VEGAS NV
89113-3701
US

V. Phone/Fax

Practice location:
  • Phone: 570-203-9222
  • Fax: 570-203-9477
Mailing address:
  • Phone: 570-203-9222
  • Fax: 570-203-9477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MARSHALL
Title or Position: BILLING MANAGER
Credential:
Phone: 570-203-9222