Edgewater Health Care, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

940000058 Issued in CA

Legal business name

EDGEWATER HEALTH CARE, INC.

Doing business as

Edgewater Skilled Nursing Center

Practice address

2625 E 4TH St
Long Beach, CA 90814-1299

Phone

(949) 240-2423

NPI assigned

Dec 9, 2005

Organization subpart

No

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

Authorized official

Name

Marc Johnson

Title

Cfo

Phone

(949) 373-8373

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• EDGEWATER SKILLED NURSING CENTER Doing business as

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

{
    "created_epoch": "1134086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1629053913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25910 ACERO STE 350",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926917908",
            "telephone_number": "949-441-9258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 E 4TH ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908141299",
            "telephone_number": "949-240-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWATER HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-09",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "949-373-8373"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "940000058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT05387I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDGEWATER SKILLED NURSING CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EDGEWATER SKILLED NURSING CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tasha Eddy
• Jaclyn Edelson, MD
• Katherine Edelstein
• Kendall Noel Ederer, PT, DPT
• Linda Vira-Leland Edgar, RN WOCN
• River Lee Edgren
• Timothy Edgren
• Eve Edmond
• Angela Edrada
• Leslie Howard Edrich, MD

• Skilled Nursing Facility in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 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.