# EDGEWOOD VISTA SENIOR LIVING INC

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

## Provider details

- **NPI number:** 1700930567
- **Authorized official:** ANN M WAGNER (ACCOUNTS RECEIVABLE CLERK)
- **Authorized official phone:** (701) 738-2000

## Contact information

- **Practice address:** 800 16TH AVE SE, MINOT, ND 58701-6781
- **Practice address phone:** (701) 852-1399
- **Mailing address:** PO BOX 13336, 2850 24TH AVE S SUITE 201, GRAND FORKS, ND 58208-3336
- **Mailing address phone:** (701) 738-2000
- **Mailing address fax:** (701) 738-2001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | 15 | ND | — |
| 311500000X | Alzheimer Center (Dementia Center) | 8057A | ND | Yes |

## Other

- **Enumeration date:** 01/22/2007
- **Last updated:** 09/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 30721 | — | ND |
| 05 | — | 39962 | — | ND |