Organization
EDGEWOOD BLAINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD DALE WHETTER (VP OF FINANCE/BUDGET)
(701) 757-5465
Entity
Organization
Contact information
Practice address
12450 CLOUD DR NE, BLAINE, MN 55449-6226
(763) 754-1723
(763) 754-1728
Mailing address
322 DEMERS AVE, SUITE 500, GRAND FORKS, ND 58201-4754
(701) 757-5465
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
29791
MN
310400000X
Assisted Living Facility
29941
MN
Other
Enumeration date
01/15/2014
Last updated
01/15/2014
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