Provider Demographics
NPI:1073652921
Name:EDEN RETIREMENT CENTER, INC.
Entity Type:Organization
Organization Name:EDEN RETIREMENT CENTER, INC.
Other - Org Name:EDEN VILLAGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-288-5014
Mailing Address - Street 1:400 S STATION RD
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-2743
Mailing Address - Country:US
Mailing Address - Phone:618-288-5014
Mailing Address - Fax:618-288-0206
Practice Address - Street 1:400 S STATION RD
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-2743
Practice Address - Country:US
Practice Address - Phone:618-288-5014
Practice Address - Fax:618-288-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0023382314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0023382OtherFACILITY LICENSE #
IL=========001Medicaid
IL0023382OtherFACILITY LICENSE #