Provider Demographics
NPI:1437621885
Name:EDGEWOOD MINOT SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:EDGEWOOD MINOT SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WHETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-757-5465
Mailing Address - Street 1:PO BOX 13238
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58208
Mailing Address - Country:US
Mailing Address - Phone:701-757-5465
Mailing Address - Fax:701-738-2001
Practice Address - Street 1:520 28TH AVE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58208
Practice Address - Country:US
Practice Address - Phone:701-852-1399
Practice Address - Fax:701-838-0613
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDGEWOOD MINOT SENIOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility