NPIMap

Organization Active NPI

Edgewood Bismarck Senior Living, LLC

  • Alzheimer Center (Dementia Center)
  • Bismarck, ND
National Provider Identifier
1770293987
Registry record updated Nov 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Alzheimer Center (Dementia Center)Taxonomy code 311500000X
Legal business name
EDGEWOOD BISMARCK SENIOR LIVING, LLC
Practice address
3124 Colorado LN
Bismarck, ND 58503-5447
Phone
(701) 738-2000
NPI assigned
Nov 29, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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

Authorized official

Name
Mr. John Dybwad
Title
VP Finance/Budget
Phone
(701) 757-5422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X Primary

Addresses

Primary practice location

3124 Colorado LN
Bismarck, ND 58503-5447

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": "1669680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1770293987",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3124 COLORADO LN",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585035447",
            "telephone_number": "701-738-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD BISMARCK SENIOR LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-29",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-22",
        "status": "A",
        "authorized_official_last_name": "DYBWAD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VP FINANCE/BUDGET",
        "authorized_official_telephone_number": "701-757-5422",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "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 Nov 29, 2022; 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.