Provider Demographics
NPI:1497949564
Name:EDEN MANAGEMENT LTD
Entity Type:Organization
Organization Name:EDEN MANAGEMENT LTD
Other - Org Name:EDEN SUPPORTIVE LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JON
Authorized Official - Last Name:HAMBLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-572-6486
Mailing Address - Street 1:940 W GORDON TERRACE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613
Mailing Address - Country:US
Mailing Address - Phone:773-472-1020
Mailing Address - Fax:773-472-2985
Practice Address - Street 1:940 W GORDON TERRACE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613
Practice Address - Country:US
Practice Address - Phone:773-472-1020
Practice Address - Fax:773-472-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid