MEDICARE: RS EDEN INC

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1073737185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RS EDEN INC

Provider Business Mailing Address
First Line	:	1931 W BROADWAY AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-2400
Country	:	US
Telephone Number	:	612-287-1600
Fax Number	:	612-287-1616

Provider Business Practice Location Address
First Line	:	1829 PORTLAND AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1812
Country	:	US
Telephone Number	:	612-872-9045
Fax Number	:	612-874-1471

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAN CAIN
Credential	:
Telephone Number	:	612-287-1600

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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Directions to “RS EDEN INC ” Practice Location

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