Provider Demographics
NPI:1386178994
Name:EDGEWOOD MANAGEMENT GROUP
Entity Type:Organization
Organization Name:EDGEWOOD MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-741-6230
Mailing Address - Street 1:322 DEMERS AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:322 DEMERS AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4754
Practice Address - Country:US
Practice Address - Phone:701-738-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based