Edgewood Blaine LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

29791 Issued in MN

Legal business name

EDGEWOOD BLAINE LLC

Practice address

12450 Cloud Dr NE
Blaine, MN 55449-6226

Phone

(763) 754-1723

Fax

(763) 754-1728

NPI assigned

Jan 15, 2014

Last updated

Jan 15, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Ronald Dale Whetter

Title

VP of Finance/Budget

Phone

(701) 757-5465

Specialties & licenses 2

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

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Edward Jones, DPM

  • Podiatrist
  • Rochester, MN
  • NPI 1639163405
  NPD (past)
• Allison N Donlan, DPT

  • Physical Therapist
  • Lacey, WA
  • NPI 1821580473
  NPD (past)

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389744000000",
    "number": "1396167953",
    "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": "701-757-5465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12450 CLOUD DR NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554496226",
            "telephone_number": "763-754-1723",
            "fax_number": "763-754-1728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD BLAINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-15",
        "last_updated": "2014-01-15",
        "status": "A",
        "authorized_official_last_name": "WHETTER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "VP OF FINANCE/BUDGET",
        "authorized_official_telephone_number": "701-757-5465",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "29941",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "29791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jessica Effertz
• Rose Ekobena

• Assisted Living Facility in Blaine, MN
• Providers in Blaine, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; 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.