Organization
EDGEWOOD HERMANTOWN I SENIOR LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RON WHETTER (VP BUDGET AND FINANCE)
(701) 738-2000
Entity
Organization
Contact information
Practice address
4195 WESTBERG RD, HERMANTOWN, MN 55811-3916
(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
338403
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
338369
—
MN
05
—
338387
—
MN
05
—
338403
—
MN
Enumeration date
12/27/2007
Last updated
05/26/2011
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