Edgewood Nursing Center Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EDGEWOOD NURSING CENTER INC

Practice address

1771 Edgewood Ave W
Jacksonville, FL 32208-3278

Phone

(904) 766-7436

Fax

(904) 766-5749

NPI assigned

Aug 10, 2005

Organization subpart

No

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

Authorized official

Name

Robert Hagan

Title

President

Phone

(770) 993-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• EdgeWood Nursing Center Doing business as

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1962404905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 CANTON ST STE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300754240",
            "telephone_number": "770-993-4000",
            "fax_number": "904-766-5749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 EDGEWOOD AVE W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322083278",
            "telephone_number": "904-766-7436",
            "fax_number": "904-766-5749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD NURSING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-10",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "HAGAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-993-4000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025487800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EdgeWood Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EdgeWood Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Victoria Edenfield, ARNP
• Diana L Edgar, M.D.
• Krystal Kay Edgar, CRNA
• Robin L Edge, SLP-CCC
• Edgewood Maximus Operations LLC
• Jonathon Curtis Edgy, MD
• Peter Ediagbonya, RPH
• Stefanie Ann Edinger, PHARMD
• Teresa A. Edison, ARNP
• Michelle L Edmonds, M.D.

• Skilled Nursing Facility in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.