# EDGEWOOD MISSOULA SENIOR LIVING LLC

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

## Provider details

- **NPI number:** 1700062957
- **Authorized official:** GENE HYSJULIEN (CEO)
- **Authorized official phone:** (701) 738-2000

## Contact information

- **Practice address:** 2815 PALMER ST, MISSOULA, MT 59808-1643
- **Practice address phone:** (406) 549-9660
- **Practice address fax:** (406) 549-4424
- **Mailing address:** 2850 24TH AVE S, SUITE 201, GRAND FORKS, ND 58201-5831
- **Mailing address phone:** (701) 738-2000
- **Mailing address fax:** (701) 738-2001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | 11326 | MT | Yes |

## Other

- **Enumeration date:** 01/18/2008
- **Last updated:** 01/18/2008