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NPI Code Detail

MEDICARE: EDEN SPRINGS ASSISTED LIVING EAST LLC

MEDICARE: EDEN SPRINGS ASSISTED LIVING EAST 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
1310400000XAssisted Living Facility0297ROH

General Provider Information

NPI Number : 1326593161
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDEN SPRINGS ASSISTED LIVING EAST LLC
Provider Business Mailing Address
First Line : 430 N BROADWAY ST
Second Line :
City : GREEN SPRINGS
State : OH
Zip : 44836-9734
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 430 N BROADWAY ST
Second Line :
City : GREEN SPRINGS
State : OH
Zip : 44836-9734
Country : US
Telephone Number : 419-639-2158
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : MAYER SPILMAN
Credential :
Telephone Number : 347-767-2060
Provider Enumeration Date : 08/22/2016
Last Update Date : 08/30/2016

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