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
2815 PALMER ST, MISSOULA, MT 59808-1643
(406) 549-9660
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
10029
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
840191
—
MT
Enumeration date
01/19/2007
Last updated
08/22/2020
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