Organization
EDGEWOOD VISTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT WILKENING (BILLING)
(701) 738-2000
Entity
Organization
Contact information
Practice address
1225 WICKS LN, BILLINGS, MT 59105-4417
(406) 256-5398
Mailing address
PO BOX 13336, GRAND FORKS, ND 58208-3336
(701) 738-2001
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
10507
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
620296
—
MT
Enumeration date
01/19/2007
Last updated
08/22/2020
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