Organization
EDGEWOOD LAKEWOOD MANDAN LLC
Active
Other names
Edgewood Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN DYBWAD (VP FINANCE/BUDGET)
(701) 738-2000
Entity
Organization
Contact information
Practice address
4401 21ST ST SE, MANDAN, ND 58554-6425
(701) 738-2000
(701) 738-2001
Mailing address
PO BOX 13238, GRAND FORKS, ND 58208-3238
(701) 738-2000
(701) 738-2001
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
311500000X
Alzheimer Center (Dementia Center)
Primary
—
—
Other
Enumeration date
11/18/2024
Last updated
02/12/2025
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