# EDGEMOOR

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1790971117
- **Authorized official:** MRS. COLEEN KAY WILSON (RN/NURSE SUPERVISOR)
- **Authorized official phone:** (619) 956-2855

## Contact information

- **Practice address:** 9065 EDGEMOOR DR, SANTEE, CA 92071-3037
- **Practice address phone:** (619) 956-2855
- **Practice address fax:** (619) 956-2981
- **Mailing address:** 9065 EDGEMOOR DR, SANTEE, CA 92071-3037
- **Mailing address phone:** (619) 956-2855
- **Mailing address fax:** (619) 956-2981

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 452469 | CA | Yes |

## Other

- **Enumeration date:** 09/19/2007
- **Last updated:** 09/19/2007