Edgewood Lakewood Mandan, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDGEWOOD LAKEWOOD MANDAN, LLC

Practice address

4401 21St St SE
Mandan, ND 58554-6425

Phone

(701) 738-2000

Fax

(701) 738-2001

NPI assigned

Nov 18, 2024

Organization subpart

No

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

Addresses

Tax ID family

Edgewood Healthcare2 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.

• Edgewood Lakewood Mandan LLC

  • Alzheimer Center (Dementia Center)
  • Mandan, ND
  • NPI 1386469021
  NPD tax ID

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

{
    "created_epoch": "1731888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731888000000",
    "number": "1841015583",
    "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": "4401 21ST ST SE",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585546425",
            "telephone_number": "701-738-2000",
            "fax_number": "701-738-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD LAKEWOOD MANDAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "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": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Easter Seals Goodwill ND, Inc.
• Easter Seals Goodwill ND, Inc.
• Easter Seals Goodwill ND, Inc.
• Eckroth Counseling, PLLC
• Edgewood Lakewood Mandan LLC
• Edgewood Mandan, LLC
• Alexandra Eldridge, BSW
• Elevate Mental Health
• Dylan Elletson, DPT
• Amy Elstrom

• Assisted Living Facility in Mandan, ND
• Providers in Mandan, ND by specialty
• Assisted Living Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; 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.