Edencrest at Kettlestone, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDENCREST AT KETTLESTONE, LLC

Practice address

805 SE Tallgrass LN
Waukee, IA 50263-6819

Phone

(515) 498-5380

NPI assigned

Jun 10, 2025

Organization subpart

No

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

Authorized official

Name

Susan Cunningham, RN

Title

Director of Wellness

Phone

(515) 510-9022

Specialties & licenses 1

Addresses

Other names 1

• Edencrest at Kettlestone, LLC Doing business as

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": "1749513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1215822366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 WESTOWN PKWY",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502662520",
            "telephone_number": "515-243-3228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 SE TALLGRASS LN",
            "city": "WAUKEE",
            "state": "IA",
            "postal_code": "502636819",
            "telephone_number": "515-498-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENCREST AT KETTLESTONE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-10",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR OF WELLNESS",
        "authorized_official_telephone_number": "515-510-9022",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edencrest at Kettlestone, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kasey Dougherty, DPT
• Dream Care LLC
• Katelynn Dutcher, ATC, LAT
• Dynamic Chiropractic and Wellness PLLC
• Eastern Iowa Therapeutics PC
• Allyson Christina Effle, SLP
• Jill Eggers, OD
• Elite Eye Care PC
• Elohim Home LLC
• Haithem Emam

• All providers in Waukee, IA
• Assisted Living Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; 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.