NPIMap

Organization Active NPI

Eden Park Management, Inc.

  • Skilled Nursing Facility
  • Brattleboro, VT
National Provider Identifier
1093885840
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EDEN PARK MANAGEMENT, INC.
Practice address
187 Oak Grove Ave
Brattleboro, VT 05301-6642
Phone
(802) 257-0307
NPI assigned
Nov 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alton Mendleson, Jr.
Title
President
Phone
(518) 436-4731

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

187 Oak Grove Ave
Brattleboro, VT 05301-6642

Mailing address

22 Holland Ave
Albany, NY 12209-1713
Phone (518) 436-4731

Other identifiers 1

IdentifierTypeStateIssuer
0475023MedicaidVT

Other names 1

  • Eden Park of Brattleboro Other name

National Provider Directory

National Provider Directory
Tax ID family
Eden Park Management Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093885840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 HOLLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122091713",
            "telephone_number": "518-436-4731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "187 OAK GROVE AVE",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053016642",
            "telephone_number": "802-257-0307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN PARK MANAGEMENT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MENDLESON, JR.",
        "authorized_official_first_name": "ALTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-436-4731"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0475023",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eden Park of Brattleboro",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Brattleboro, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.