Edgewood Vista Senior Living Inc
Legal Business Name
Edgewood Vista Senior Living Inc
NPI Number
1932252376
NPI Type
Organization
Enumeration Date
01/19/2007
Specialties
(Taxonomies)Code
311500000X
310400000X
Primary Taxonomy
No
No
Licenses
State
North Dakota
North Dakota
North Dakota
North Dakota
License Number
8058A
8057A
1
15
Contact
Information
Purpose
Mailing
Location
Address
PO BOX 13336
3406 DOMINION ST
City
Grand Forks
Bismarck
State
ND
ND
Postal Code
58208-3336
58503-5577
Country
US
US
Telephone Number
(701) 738-2000
(701) 258-7489
Authorized Official
Name
Ann Wagner
Title or Position
ACCOUNTS RECEIVABLE CLERK
Telephone Number
(701) 738-2000
Identifiers
Identifier
30751
39962
30721
32083
Identifier State
ND
ND
ND
ND
Identifier Issuer
Unknown
Unknown
Unknown
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 08/22/2020