Edge Health Care and Mental Health Services

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

Legal business name

EDGE HEALTH CARE AND MENTAL HEALTH SERVICES

Practice address

157 Grass Lake PL Apt 309
Shoreview, MN 55126-2063

Phone

(763) 498-4448

NPI assigned

May 14, 2024

Organization subpart

No

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

Authorized official

Name

Ekan Ekong, NP

Title

Pmhnp-BC

Phone

(763) 498-4448

Specialties & licenses 6

Addresses

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

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1467201301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 GRASS LAKE PL APT 309",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551262063",
            "telephone_number": "763-498-4448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 GRASS LAKE PL APT 309",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551262063",
            "telephone_number": "763-498-4448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGE HEALTH CARE AND MENTAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "EKONG",
        "authorized_official_first_name": "EKAN",
        "authorized_official_title_or_position": "PMHNP-BC",
        "authorized_official_telephone_number": "763-498-4448",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ecumen
• Ecumen
• Ecumen
• Ecumen
• Ecumen
• Jasmine Egli
• Chad Alan Eiswald, D.C.
• Ekan J Ekong, CNP
• Elaine K Johnson Ma LP Ladc PLLC
• Barbara Elfstrom, MD

• Children's Substance Abuse Rehabilitation Facility in Shoreview, MN
• Providers in Shoreview, MN by specialty
• Children's Substance Abuse Rehabilitation Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; 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.