EDGEWOOD FARGO SENIOR LIVING LLC NPI 1619148467

NPI Information

EDGEWOOD FARGO SENIOR LIVING, LLC is an assisted living facility in Fargo, ND. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. EDGEWOOD FARGO SENIOR LIVING, LLC NPI is 1619148467. The provider is registered as an organization entity type.

The provider's business location address is:

4420 37TH AVE S
FARGO, ND
ZIP 58104-400
Phone: (701) 365-8200
Fax: (701) 365-8202

The provider's authorized official is Gene Hysjulien .
The authorized official title is Ceo and has the following contact phone number (701) 738-2000.

The CLIA number assigned to this NPI record is 35D1071179 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/20/2008 and was last updated on 3/20/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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