# EDGEWOOD OMAHA SENIOR LIVING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114216561
- **Authorized official:** MR. REX CARLSON CPA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (701) 738-2000

## Contact information

- **Practice address:** 17620 POPPLETON AVE., OMAHA, NE 68130-4614
- **Practice address phone:** (402) 333-5749
- **Practice address fax:** (402) 697-3998
- **Mailing address:** 17620 POPPLETON AVE., OMAHA, NE 68130-4614
- **Mailing address phone:** (402) 333-5749
- **Mailing address fax:** (402) 697-3998

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | 2801060340 | NE | Yes |

## Other

- **Enumeration date:** 04/06/2011
- **Last updated:** 04/06/2011