Provider Demographics
NPI:1659354355
Name:EDGEWOOD RETIREMENT COMMUNITY, INC
Entity Type:Organization
Organization Name:EDGEWOOD RETIREMENT COMMUNITY, INC
Other - Org Name:THE MEADOWS AT EDGEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-725-3300
Mailing Address - Street 1:575 OSGOOD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1975
Mailing Address - Country:US
Mailing Address - Phone:978-725-3300
Mailing Address - Fax:978-725-5997
Practice Address - Street 1:575 OSGOOD ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1975
Practice Address - Country:US
Practice Address - Phone:978-725-3300
Practice Address - Fax:978-725-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOTTG314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225724Medicare ID - Type Unspecified