Organization

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

Provider Address