Organization
EDGEBROOK CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DOUGHTY (ADMINISTRATOR)
(507) 442-7121
Entity
Organization
Contact information
Practice address
505 W TROSKY RD, EDGERTON, MN 56128-2748
(507) 442-7121
(507) 442-3952
Mailing address
505 W TROSKY RD, EDGERTON, MN 56128-2748
(507) 442-7121
(507) 442-3952
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030824003
PRIME WEST
MN
01
—
7122565
EVERCARE-MEDICA
MN
05
—
767842800
—
MN
01
—
9508ED
BCBS
MN
01
—
NH0481
UCARE
MN
Enumeration date
12/28/2005
Last updated
12/28/2012
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