NPIMap

Organization Active NPI

Edgewood Vista Senior Living Inc

  • Assisted Living Facility
  • Spearfish, SD
National Provider Identifier
1548313992
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
11073 Issued in SD
Legal business name
EDGEWOOD VISTA SENIOR LIVING INC
Practice address
540 Falcon Crest Dr
Spearfish, SD 57783-3255
Phone
(605) 642-2977
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Ann M Wagner
Title
Accounts Receivable Clerk
Phone
(701) 738-2000

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 49736 SD
Assisted Living Facility 310400000X 11073 SD Primary
Alzheimer Center (Dementia Center) 311500000X 49736 SD
Alzheimer Center (Dementia Center) 311500000X 11073 SD

Addresses

Primary practice location

540 Falcon Crest Dr
Spearfish, SD 57783-3255

Mailing address

PO Box 13336
2450 24TH Ave S Suite 201
Grand Forks, ND 58208-3336
Phone (701) 738-2000

Other identifiers 1

IdentifierTypeStateIssuer
9570693MedicaidSD

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": "1757548800000",
    "number": "1548313992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13336",
            "address_2": "2450 24TH AVE S SUITE 201",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582083336",
            "telephone_number": "701-738-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 FALCON CREST DR",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577833255",
            "telephone_number": "605-642-2977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD VISTA SENIOR LIVING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE CLERK",
        "authorized_official_telephone_number": "701-738-2000"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SD",
            "license": "49736",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SD",
            "license": "11073",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "SD",
            "license": "49736",
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "SD",
            "license": "11073",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9570693",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spearfish, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.