Provider Demographics
NPI:1780910117
Name:EDGEWOOD ALEXANDRIA SENIOR LIVING LLC
Entity type:Organization
Organization Name:EDGEWOOD ALEXANDRIA SENIOR LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-757-4700
Mailing Address - Street 1:2850 24TH AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5831
Mailing Address - Country:US
Mailing Address - Phone:701-738-2000
Mailing Address - Fax:701-738-2001
Practice Address - Street 1:1902 7TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2364
Practice Address - Country:US
Practice Address - Phone:320-759-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility