NPIMap

Organization Active NPI

Edgewood Prairie Crossings Watertown, LLC

  • Assisted Living Facility
  • Watertown, SD
National Provider Identifier
1114353224
Registry record updated Sep 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
10738 Issued in SD
Legal business name
EDGEWOOD PRAIRIE CROSSINGS WATERTOWN, LLC
Practice address
424 9TH St SE
Watertown, SD 57201-4554
Phone
(605) 882-9003
Fax
(605) 882-9433
NPI assigned
Sep 20, 2013
Last updated
Sep 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2013

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

Authorized official

Name
Barbara Kramer
Title
Director of Utilization Review
Phone
(701) 317-0892

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 10738 SD Primary

Addresses

Primary practice location

424 9TH St SE
Watertown, SD 57201-4554

Mailing address

322 Demers Ave
Suite 500
Grand Forks, ND 58201-4754
Phone (701) 317-0892

National Provider Directory

National Provider Directory
Tax ID family
Edgewood Prairie Crossings Watertown2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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": "1379635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379635200000",
    "number": "1114353224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 DEMERS AVE",
            "address_2": "SUITE 500",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014754",
            "telephone_number": "701-317-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 9TH ST SE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572014554",
            "telephone_number": "605-882-9003",
            "fax_number": "605-882-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD PRAIRIE CROSSINGS WATERTOWN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-20",
        "last_updated": "2013-09-20",
        "status": "A",
        "authorized_official_last_name": "KRAMER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "DIRECTOR OF UTILIZATION REVIEW",
        "authorized_official_telephone_number": "701-317-0892"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SD",
            "license": "10738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; 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.