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Organization

EDGEWOOD VIRGINIA I SENIOR LIVING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GENE HYSJULIEN (CEO)
(701) 738-2000
Entity
Organization

Contact information

Practice address
705 17TH ST N, VIRGINIA, MN 55792-2176
(701) 738-2000
(701) 738-2001
Mailing address
2850 24TH AVE S, SUITE 201, GRAND FORKS, ND 58201-5831
(701) 738-2000
(701) 738-2001

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
338389
MN
310400000X
Assisted Living Facility
338401
MN
311500000X
Alzheimer Center (Dementia Center)
338390
MN

Other

Enumeration date
12/28/2007
Last updated
12/28/2007
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