Organization
EDGEWOOD HASTINGS SENIOR LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REX CARLSON CPA (CHIEF FINANCIAL OFFICER)
(701) 738-2000
Entity
Organization
Contact information
Practice address
2400 W. 12TH ST., HASTINGS, NE 68901-3501
(402) 462-4633
(402) 462-6828
Mailing address
2400 W. 12TH ST., HASTINGS, NE 68901-3501
(402) 462-4633
(402) 462-6828
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
28D1059768
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025787300
—
NE
Enumeration date
04/06/2011
Last updated
04/06/2011
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