Organization
EDGEWOOD VISTA SENIOR LIVING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN M WAGNER (ACCOUNTS RECEIVABLE CLERK)
(701) 738-2000
Entity
Organization
Contact information
Practice address
540 FALCON CREST DR, SPEARFISH, SD 57783-3255
(605) 642-2977
Mailing address
PO BOX 13336, 2450 24TH AVE S SUITE 201, GRAND FORKS, ND 58208-3336
(701) 738-2000
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
11073
SD
310400000X
Assisted Living Facility
49736
SD
311500000X
Alzheimer Center (Dementia Center)
11073
SD
311500000X
Alzheimer Center (Dementia Center)
49736
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9570693
—
SD
Enumeration date
01/19/2007
Last updated
09/11/2025
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