Edgewood Fargo Senior Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

70 Issued in ND

Legal business name

EDGEWOOD FARGO SENIOR LIVING, LLC

Practice address

4420 37TH Ave S
Fargo, ND 58104-3400

Phone

(701) 365-8200

Fax

(701) 365-8202

NPI assigned

Mar 20, 2008

Last updated

Mar 20, 2008By 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 1

Addresses

Tax ID family

Edgewood Fargo 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 Fargo Senior Living LLC

  • Alzheimer Center (Dementia Center)
  • Fargo, ND
  • NPI 1588826390
  NPD tax ID

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

{
    "created_epoch": "1205971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205971200000",
    "number": "1619148467",
    "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": "4420 37TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581043400",
            "telephone_number": "701-365-8200",
            "fax_number": "701-365-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD FARGO SENIOR LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-20",
        "last_updated": "2008-03-20",
        "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": "ND",
            "license": "70",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irankunda Eddy Walcott
• Edencarel.L.C
• Edencarel.L.C
• Holly Ann Edgecombe, LMT
• Edgewood Fargo Senior Living LLC
• Barbara L Edin, PT
• Edison Chiropractic
• Jacob Edland, CRNA
• Chelsey Lee Edwards, MOTR/L
• Mariah Edwards

• Assisted Living Facility in Fargo, ND
• Providers in Fargo, ND by specialty
• Assisted Living Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; 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.