# EDEN MANOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205280120
- **Authorized official:** MS. MICHELLE NICOLE ROSS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (314) 814-2594

## Contact information

- **Practice address:** 1361 ARLINGTON AVE, SAINT LOUIS, MO 63112-4131
- **Practice address phone:** (314) 833-4313
- **Practice address fax:** (314) 833-4313
- **Mailing address:** 1361 ARLINGTON AVE, SAINT LOUIS, MO 63112-4131
- **Mailing address phone:** (314) 833-4313
- **Mailing address fax:** (314) 833-4313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | LC9786208 | MO | Yes |

## Other

- **Enumeration date:** 04/17/2016
- **Last updated:** 04/17/2016