NPIMap

Organization Active NPI

Edgewood Hermantown 1 Senior Living LLC

  • Assisted Living Facility
  • Hermantown, MN
National Provider Identifier
1699189381
Registry record updated Jun 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
363096 Issued in MN
Legal business name
EDGEWOOD HERMANTOWN 1 SENIOR LIVING LLC
Practice address
4175 Westberg Rd
Hermantown, MN 55811-3916
Phone
(218) 723-8905
Fax
(218) 723-4051
NPI assigned
Jun 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2014

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

Authorized official

Name
Mr. Ron Whetter
Title
VP of Finance/Budget
Phone
(701) 757-5465

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 363096 MN Primary

Addresses

Primary practice location

4175 Westberg Rd
Hermantown, MN 55811-3916

Mailing address

322 Demers Ave
Suite 500
Grand Forks, ND 58201-4754
Phone (701) 757-5465

National Provider Directory

National Provider Directory
Tax ID family
Edgewood Hermantown 1 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.

NPI Registry JSON

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

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403222400000",
    "number": "1699189381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 DEMERS AVE",
            "address_2": "SUITE 500",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014754",
            "telephone_number": "701-757-5465",
            "fax_number": "701-738-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4175 WESTBERG RD",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558113916",
            "telephone_number": "218-723-8905",
            "fax_number": "218-723-4051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD HERMANTOWN 1 SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-20",
        "last_updated": "2014-06-20",
        "status": "A",
        "authorized_official_last_name": "WHETTER",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "VP OF FINANCE/BUDGET",
        "authorized_official_telephone_number": "701-757-5465",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "363096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hermantown, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; 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.