Organization
EDGEWOOD WATERTOWN MC 2 LLC
Active
Parent organization
EDGEWOOD OPCO LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EDGEWOOD OPCO LLC
Authorized official
TRUDI L MOSTELLER (REGIONAL CONTROLLER)
(701) 757-5410
Entity
Organization
Contact information
Practice address
225 14 AVE NE, WATERTOWN, SD 57201
(701) 757-5410
(701) 738-2001
Mailing address
322 DEMERS AVE STE 500, GRAND FORKS, ND 58201
(701) 757-5410
(701) 757-2001
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
11/06/2018
Last updated
11/06/2018
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