Active NPI
Edgewood Retirement Community, Inc
- Skilled Nursing Facility
- North Andover, MA
National Provider Identifier
1659354355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- OTTG
- Legal business name
- EDGEWOOD RETIREMENT COMMUNITY, INC
- Practice address
- 575 Osgood St
North Andover, MA 01845-1975 - Phone
- (978) 725-3300
- Fax
- (978) 725-5997
- NPI assigned
- Nov 28, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Marlene Rotering
- Title
- Executive Director
- Phone
- (978) 725-3300
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | OTTG | MA | Primary |
Addresses
Primary practice location
575 Osgood St
North Andover, MA 01845-1975
Mailing address
575 Osgood St
North Andover, MA 01845-1975
Phone (978) 725-3300
Other names 1
- The Meadows at Edgewood
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060809000183 | MA | Part A Provider - Skilled Nursing Facility | 4789687948 | Practice locations: North Andover, MA |
Skilled nursing facility certification: CCN 225724
- Legal name
- EDGEWOOD RETIREMENT COMMUNITY, INC.
- Doing business as
- THE MEADOWS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF (Medicare) only
- Participating since
- Mar 4, 1997
- Last certification
- Sep 5, 2024
- Beds
- 60
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- Mar 16, 1993 in MA
- Enrollment address
- 575 Osgood St
North Andover, MA 01845-1975 - Nursing home name
- MEADOWS, THE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Meadows, The
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare
- Ownership
- Non profit - Corporation
- Certified
- Mar 4, 1997
- Medicare certification status
- Active
- Certified beds
- 60
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 22D0921929 | Meadows of Edgewood, the | Certificate of waiver | Nov 7, 2026 |
National Provider Directory
National Provider DirectoryMember organizations 1
Organizations listed as members of this organization in the National Provider Directory.
-
- Family Nurse Practitioner
- North Andover, MA
- NPI 1346564689
Member Of
Ownership & related parties
All disclosed owners & managing parties 20
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Bryan Deveau | Corporate Director | Nov 19, 2018 | 100% |
| W-2 Managing Employee | Nov 19, 2018 | 100% | |
| Michael Consoli | Corporate Director | Jun 13, 2019 | |
| Eliott Hacker | Corporate Director | Jun 9, 2017 | |
| Hugo Overdeput | Corporate Director | Jun 9, 2020 | |
| Natalie Y Macbrien | Corporate Director | Sep 10, 2019 | 100% |
| W-2 Managing Employee | Aug 20, 2012 | 100% | |
| Paul a Hedstrom | Corporate Director | Jun 9, 2017 | |
| Richard Sumberg | Corporate Director | Jun 9, 2020 | |
| Marlene Hoyt | Corporate Director | Jun 9, 2017 | |
| Melissa Kampersal | Corporate Officer | Jan 1, 2018 | 100% |
| Henry White | Corporate Director | Jun 9, 2020 | |
| Marlene Rotering | Corporate Officer | May 1, 2012 | 100% |
| W-2 Managing Employee | May 1, 2012 | 100% | |
| Timothy Vaill | Corporate Director | Jun 9, 2017 | |
| Edgewood Retirement Community, Inc. | 5% Or Greater Direct Ownership Interest | May 20, 2010 | 100% |
| Donald Piccirillo | Corporate Director | Jun 9, 2017 | |
| Josh Young | Corporate Director | Jun 13, 2019 | |
| Jane Sullivan | Corporate Officer | Jun 1, 2014 | 100% |
| W-2 Managing Employee | May 20, 2010 | ||
| Thomas Smith | Corporate Director | Jun 9, 2017 | |
| Elizabeth Barbadoro | Corporate Director | Jun 9, 2020 | |
| Sayeeda Rahman | Corporate Director | Jun 9, 2017 | |
| Camille Miragliotta | Corporate Director | Jun 16, 2019 |
Practitioners & affiliated clinicians
Affiliated clinicians 1
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133136000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1659354355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "575 OSGOOD ST",
"city": "NORTH ANDOVER",
"state": "MA",
"postal_code": "018451975",
"telephone_number": "978-725-3300",
"fax_number": "978-725-5997"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "575 OSGOOD ST",
"city": "NORTH ANDOVER",
"state": "MA",
"postal_code": "018451975",
"telephone_number": "978-725-3300",
"fax_number": "978-725-5997"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EDGEWOOD RETIREMENT COMMUNITY, INC",
"organizational_subpart": "NO",
"enumeration_date": "2005-11-28",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "ROTERING",
"authorized_official_first_name": "MARLENE",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "978-725-3300"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MA",
"license": "OTTG",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "The Meadows at Edgewood",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in North Andover, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.