Edencrest at Beaverdale

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

S0369 Issued in IA

Legal business name

EDENCREST AT BEAVERDALE

Practice address

3410 Beaver Ave
Des Moines, IA 50310-3271

Phone

(515) 777-5105

Fax

(515) 777-1969

NPI assigned

Dec 6, 2017

Organization subpart

Yes

Parent organization

BEAVERDALE SENIOR LIVING, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Sam Patterson

Title

Manager

Phone

(515) 777-5105

Specialties & licenses 1

Addresses

Other identifiers 1

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

CLIA laboratory certificates

Part of

Edencrest at Beaverdale

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1427563022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3410 BEAVER AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503103271",
            "telephone_number": "515-777-5105",
            "fax_number": "515-777-1969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 BEAVER AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503103271",
            "telephone_number": "515-777-5105",
            "fax_number": "515-777-1969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENCREST AT BEAVERDALE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEAVERDALE SENIOR LIVING, LLC",
        "enumeration_date": "2017-12-06",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "515-777-5105",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IA",
            "license": "S0369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA DEPARTMENT OF INSPECTIONS AND APPEALS",
            "identifier": "S0369",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas Stephen Economos, DDS
• Peter Economos
• Shea Eddy
• Matthew Thomas Edel, D.O.
• Kent James Edelman, MD
• Paige Edgington
• Jessica Edler, PHD, LAT, ATC
• Dyann M Edwards, ARNP-C
• Jennifer Anne Edwards, DPT
• Justin Edwards, BS

• Assisted Living Facility in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Assisted Living Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.