Edgewood Omaha Senior Living

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

2801060340 Issued in NE

Legal business name

EDGEWOOD OMAHA SENIOR LIVING

Practice address

17620 Poppleton Ave.
Omaha, NE 68130-4614

Phone

(402) 333-5749

Fax

(402) 697-3998

NPI assigned

Apr 6, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Rex Carlson, CPA

Title

Chief Financial Officer

Phone

(701) 738-2000

Specialties & licenses 1

Addresses

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": "1302048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302048000000",
    "number": "1114216561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17620 POPPLETON AVE.",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681304614",
            "telephone_number": "402-333-5749",
            "fax_number": "402-697-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17620 POPPLETON AVE.",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681304614",
            "telephone_number": "402-333-5749",
            "fax_number": "402-697-3998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD OMAHA SENIOR LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-06",
        "last_updated": "2011-04-06",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "REX",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "701-738-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NE",
            "license": "2801060340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren E Edet
• Edg Company LLC
• Joshua S Edgar, MD
• Amanda Edgecomb
• Chloe Edgell
• Brandie Edgman, APRN
• Greg Lee Edgman
• Awovi Carole Edih
• James Edison
• Jennifer Edison

• Alzheimer Center (Dementia Center) in Omaha, NE
• Providers in Omaha, NE by specialty
• Alzheimer Center (Dementia Center) in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; 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.