Healthcare Provider Details

I. General information

NPI: 1770038515
Provider Name (Legal Business Name): EDEN SPRINGS NURSING AND REHABILITATION EAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N BROADWAY ST
GREEN SPRINGS OH
44836-9734
US

IV. Provider business mailing address

430 N BROADWAY ST
GREEN SPRINGS OH
44836-9734
US

V. Phone/Fax

Practice location:
  • Phone: 419-639-2626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MAYER SPILMAN
Title or Position: MEMBER
Credential:
Phone: 347-767-2060