MEDICARE: EDEN TREATMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1043879083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN TREATMENT, LLC

Provider Business Mailing Address
First Line	:	512 NORTHAMPTON ST
Second Line	:
City	:	EDWARDSVILLE
State	:	PA
Zip	:	18704-4560
Country	:	US
Telephone Number	:	570-203-9222
Fax Number	:	570-203-9477

Provider Business Practice Location Address
First Line	:	3636 DUTCH VALLEY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-6806
Country	:	US
Telephone Number	:	570-203-9222
Fax Number	:	570-203-9477

Authorized Official
Title or Position	:	DIRECTOR, BILLING & COLLECTIONS
Name	:	MELISSA MARSHALL
Credential	:
Telephone Number	:	570-203-9222

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	03/14/2024

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