Edgewood Vista Senior Living, Inc

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

8057A Issued in ND

Legal business name

EDGEWOOD VISTA SENIOR LIVING, INC

Practice address

715 17TH Ave SE
Minot, ND 58701-6753

Phone

(701) 838-5569

Fax

(701) 838-0613

NPI assigned

Mar 24, 2008

Last updated

Mar 24, 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 Minot Senior Living LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Edgewood Minot Senior Living, LLC

  • Assisted Living Facility
  • Minot, ND
  • NPI 1437621885
  NPD tax ID
• Edgewood Minot Senior Living, LLC

  • Assisted Living Facility
  • Minot, ND
  • NPI 1851562607
  NPD tax ID

Locations

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206316800000",
    "number": "1740452374",
    "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": "715 17TH AVE SE",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587016753",
            "telephone_number": "701-838-5569",
            "fax_number": "701-838-0613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD VISTA SENIOR LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2008-03-24",
        "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": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "ND",
            "license": "8057A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Eckert
• Lacey Eckmann
• Edgewood Minot Senior Living, LLC
• Edgewood Minot Senior Living, LLC
• Edgewood Vista Senior Living Inc
• Monica Edmundson
• Bailee Edwards
• Bianca Edwards
• Robert Buster Edwards Jr., ED. D.
• Madison Marie Ehlke

• Alzheimer Center (Dementia Center) in Minot, ND
• Providers in Minot, ND by specialty
• Alzheimer Center (Dementia Center) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.