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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1326702531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN TREATMENT, LLC

Provider Business Mailing Address
First Line	:	270 PIERCE ST STE 208
Second Line	:
City	:	KINGSTON
State	:	PA
Zip	:	18704-5141
Country	:	US
Telephone Number	:	570-203-9222
Fax Number	:	570-203-9477

Provider Business Practice Location Address
First Line	:	2341 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6708
Country	:	US
Telephone Number	:	570-203-9222
Fax Number	:	570-203-9477

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MELISSA MARSHALL
Credential	:
Telephone Number	:	570-203-9222

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	10/25/2021

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