Edgewood Hermantown I Senior Living LLC
Organization Active NPI Assisted Living Facility · Hermantown, MN
NPI 1609050442 · NPPES record last updated May 26, 2011
Key facts
- NPI
- 1609050442
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- 338403 (MN)
- Legal business name
- EDGEWOOD HERMANTOWN I SENIOR LIVING LLC
- Practice address
- 4195 Westberg Rd
Hermantown, MN 55811-3916 - Phone
- (701) 738-2000
- Fax
- (701) 738-2001
- NPI assigned
- Dec 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Ron Whetter
- Title
- VP Budget and Finance
- Phone
- (701) 738-2000
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- Edgewood Hermantown 1 Senior Living LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 338403 | MN | Yes |
Addresses
Primary practice location
4195 Westberg Rd
Hermantown, MN 55811-3916
Mailing address
2850 24TH Ave S
Suite 201
Grand Forks, ND 58201-5831
Phone (701) 738-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 338387 | Medicaid | MN | |
| 338369 | Medicaid | MN | |
| 338403 | Medicaid | MN |
Other providers in Hermantown, MN
- Holly Renee Duren
- Katie Nicole East
- Sarah Marie Ebmer
- Brooke Marie Eddy
- Edgewood Hermantown 1 Senior Living LLC
- Edgewood Hermantown II Senior Living LLC
- Mara Suzanne Edison
- Jaden Ellefson
- Lucas Michael Elsner
- Cassie Endsley
All providers in Hermantown, MN · Assisted Living Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.