EDENCREST AT KETTLESTONE LLC NPI 1215822366

NPI Information

NPI: 1215822366
Provider Name: EDENCREST AT KETTLESTONE, LLC
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
CLIA Number: 16D2305489
Address: 805 SE TALLGRASS LN
WAUKEE, IA
ZIP 50263
Phone: (515) 498-5380

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NPI Details

EDENCREST AT KETTLESTONE, LLC is an assisted living facility in Waukee, IA. 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. EDENCREST AT KETTLESTONE, LLC NPI is 1215822366. The provider is registered as an organization entity type.

The provider's business location address is:

805 SE TALLGRASS LN
WAUKEE, IA
ZIP 50263-819
Phone: (515) 498-5380

The provider's authorized official is Susan Cunningham .
The authorized official title is Director Of Wellness and has the following contact phone number (515) 510-9022.

The CLIA number assigned to this NPI record is 16D2305489 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/10/2025 and was last updated on 6/13/2025.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility				Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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