NPIMap

Organization Active NPI

Edgewood Vista

  • Assisted Living Facility
  • Missoula, MT
National Provider Identifier
1366595597
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
10029 Issued in MT
Legal business name
EDGEWOOD VISTA
Practice address
2815 Palmer St
Missoula, MT 59808-1643
Phone
(406) 549-9660
NPI assigned
Jan 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Brett Wilkening
Title
Billing
Phone
(701) 738-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 10029 MT Primary

Addresses

Primary practice location

2815 Palmer St
Missoula, MT 59808-1643

Mailing address

PO Box 13336
Grand Forks, ND 58208-3336

Other identifiers 1

IdentifierTypeStateIssuer
840191MedicaidMT

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D1058159Edgewood Vista - Missoula2815 Palmer, Missoula, MT 59808Certificate of waiverAug 29, 2026

National Provider Directory

National Provider Directory
Tax ID family
Edgewood Vista8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366595597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13336",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582083336",
            "fax_number": "701-738-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2815 PALMER ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081643",
            "telephone_number": "406-549-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD VISTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILKENING",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "701-738-2000"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MT",
            "license": "10029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "840191",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.