NPIMap

Organization Active NPI

Edgewood Bismarck Senior Living, LLC

  • Alzheimer Center (Dementia Center)
  • Bismarck, ND
National Provider Identifier
1659543288
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Alzheimer Center (Dementia Center)Taxonomy code 311500000X
License
8058A Issued in ND
Legal business name
EDGEWOOD BISMARCK SENIOR LIVING, LLC
Practice address
3406 Dominion St
Bismarck, ND 58503-5577
Phone
(701) 258-7489
Fax
(701) 258-7491
NPI assigned
Mar 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Authorized official

Name
John Dybwad
Title
VP Finance/Budget
Phone
(701) 738-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X 8058A ND Primary

Addresses

Primary practice location

3406 Dominion St
Bismarck, ND 58503-5577

Mailing address

PO Box 13238
Grand Forks, ND 58208-3238
Phone (701) 738-2000

National Provider Directory

National Provider Directory
Tax ID family
Edgewood Bismarck Senior Living LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1659543288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13238",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582083238",
            "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": "3406 DOMINION ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585035577",
            "telephone_number": "701-258-7489",
            "fax_number": "701-258-7491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD BISMARCK SENIOR LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "DYBWAD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VP FINANCE/BUDGET",
        "authorized_official_telephone_number": "701-738-2000"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "ND",
            "license": "8058A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.