Edgewood Watertown MC 2 LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDGEWOOD WATERTOWN MC 2 LLC

Practice address

225 14 Ave NE
Watertown, SD 57201

Phone

(701) 757-5410

Fax

(701) 738-2001

NPI assigned

Nov 6, 2018

Organization subpart

Yes

Parent organization

EDGEWOOD OPCO LLCAs reported in NPPES

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

Authorized official

Name

Trudi L Mosteller

Title

Regional Controller

Phone

(701) 757-5410

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541462400000",
    "number": "1326516501",
    "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": "58201",
            "telephone_number": "701-757-5410",
            "fax_number": "701-757-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 14 AVE NE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "57201",
            "telephone_number": "701-757-5410",
            "fax_number": "701-738-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD WATERTOWN MC 2 LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDGEWOOD OPCO LLC",
        "enumeration_date": "2018-11-06",
        "last_updated": "2018-11-06",
        "status": "A",
        "authorized_official_last_name": "MOSTELLER",
        "authorized_official_first_name": "TRUDI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "REGIONAL CONTROLLER",
        "authorized_official_telephone_number": "701-757-5410"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; 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.