Edgewood Prairie Crossings Watertown Il LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDGEWOOD PRAIRIE CROSSINGS WATERTOWN IL LLC

Practice address

901 14TH Ave NE
Watertown, SD 57201-6817

Phone

(605) 882-3084

NPI assigned

Dec 4, 2015

Last updated

Dec 4, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rex Carlson

Title

Treasurer

Phone

(701) 757-5463

Specialties & licenses 1

Addresses

Other names 1

• Edgewood The Commons Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449187200000",
    "number": "1083089825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 DEMERS AVE STE 500",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014799",
            "telephone_number": "701-757-5410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 14TH AVE NE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572016817",
            "telephone_number": "605-882-3084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD PRAIRIE CROSSINGS WATERTOWN IL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-04",
        "last_updated": "2015-12-04",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "REX",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "701-757-5463"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgewood The Commons",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sarah Jo Dykstra, LCSW-PIP
• Carrie J Dylla, PAC
• Eagle Vision
• Sydney Ebben-Carmody, DDS
• Edgewood Prairie Crossings Watertown
• Edgewood Prairie Crossings Watertown, LLC
• Edgewood Watertown MC 2 LLC
• Jenna Ehlis, DDS
• Hanna Eide, CNP
• Tiffany Dawn Eide, COTA/L

• Assisted Living Facility in Watertown, SD
• Providers in Watertown, SD by specialty
• Assisted Living Facility in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.