MEDICARE: EDEN PARADISE ASSISTED LIVING,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	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073133997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN PARADISE ASSISTED LIVING,LLC

Provider Business Mailing Address
First Line	:	6 NW 35TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-6932
Country	:	US
Telephone Number	:	239-282-2556
Fax Number	:	239-282-1558

Provider Business Practice Location Address
First Line	:	6 NW 35TH AVE
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-6932
Country	:	US
Telephone Number	:	239-282-2556
Fax Number	:	239-282-1558

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JEANNE TAMAS
Credential	:
Telephone Number	:	239-645-5003

Provider Enumeration Date	:	04/21/2020
Last Update Date	:	04/21/2020

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