Edgewood Jamestown,LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDGEWOOD JAMESTOWN,LLC

Practice address

322 Demers Ave
Suite 500
Grand Forks, ND 58201-4754

Phone

(701) 757-5465

NPI assigned

Aug 28, 2016

Last updated

Aug 28, 2016By 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

Mr. Rex Carlson

Title

Cfo

Phone

(701) 757-5463

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472342400000",
    "number": "1891241139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 25TH STREET SW",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "58401",
            "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": "322 DEMERS AVE",
            "address_2": "SUITE 500",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014754",
            "telephone_number": "701-757-5465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD JAMESTOWN,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2016-08-28",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "REX",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "701-757-5463",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lily Marie Eberts
• Ellie Elizabeth Eckart
• Tiahna Edevold
• Edgewood Grand Forks LLC
• Edgewood Grand Forks LLC
• Edgewood Management Group
• Edgewood Parkwood Place,LLC
• Edgewood Sartell LLC
• Cory Thomas Edwards, MD
• Jules Efta, DC

• Assisted Living Facility in Grand Forks, ND
• Providers in Grand Forks, 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 Aug 28, 2016; 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.