Edgewood Virginia I Senior Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

338389 Issued in MN

Legal business name

EDGEWOOD VIRGINIA I SENIOR LIVING LLC

Practice address

705 17TH St N
Virginia, MN 55792-2176

Phone

(701) 738-2000

Fax

(701) 738-2001

NPI assigned

Dec 28, 2007

Last updated

Dec 28, 2007By 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

Gene Hysjulien

Title

Ceo

Phone

(701) 738-2000

Specialties & licenses 3

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

Tax ID family

Edgewood Virginia I Senior Living LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Edgewood Virginia Senior Living LLC

  • Assisted Living Facility
  • Virginia, MN
  • NPI 1518372226
  NPD tax ID

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

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1508040395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2850 24TH AVE S",
            "address_2": "SUITE 201",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015831",
            "telephone_number": "701-738-2000",
            "fax_number": "701-738-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 17TH ST N",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "557922176",
            "telephone_number": "701-738-2000",
            "fax_number": "701-738-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD VIRGINIA I SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-28",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "HYSJULIEN",
        "authorized_official_first_name": "GENE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-738-2000"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "338401",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "338389",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "MN",
            "license": "338390",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan M Doran, PT
• Mercede Doty
• Jordyn Renee Drees
• Maegan Joanne Duchene
• Theresa Marie Duffy, CRNA
• Edgewood Virginia Senior Living LLC
• Kristine Lee Edstrom, LPCC
• Nancy Eichholz, RN, CNP
• Vanessa A Eichorn
• Christian Eikam

• Assisted Living Facility in Virginia, MN
• Providers in Virginia, 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 Dec 28, 2007; 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.