EDGEWOOD WATERTOWN MC 2 LLC (NPI# 1326516501) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326516501 |
| Entity Type | Organization |
| Organization Name | EDGEWOOD WATERTOWN MC 2 LLC |
| Practice Address |
225 14 Ave Ne Watertown SD 57201 |
| Mailing Address |
322 Demers Ave Ste 500 Grand Forks ND 58201 |
| Practice Telephone | 7017575410 |
| Practice Fax Number | 7017382001 |
| Mailing Telephone | 7017575410 |
| Mailing Fax Number | 7017572001 |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2018-11-06 |
| Authorized Official Name | TRUDI L MOSTELLER (REGIONAL CONTROLLER) |
| Authorized Official Telephone | 7017575410 |
| Is Organization Subpart | Y |
| Parent Organization Name | EDGEWOOD OPCO LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Street Address |
225 14 AVE NE |
| City | WATERTOWN |
| State | SD |
| Zip Code | 57201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245878032 | Samantha Kay Kratovil | Dietitian, Registered | 4 19th St Ne, Watertown, SD 57201 | 2019-12-12 |
| 1023503406 | Rhonda Jean Cyre | Occupational Therapy Assistant | 613 B 1st Ave Se, Watertown, SD 57201 | 2018-06-27 |
| 1083160717 | Joyce Anderson | Psychologist | 1124 Konrady Dr. Ne, Watertown, SD 57201 | 2016-09-01 |
| 1336584630 | Jeffrey Alan Dorrity | Otolaryngology | 1201 Mickelson Dr, Watertown, SD 57201 | 2013-05-01 |
| 1427397389 | Vickie Lynn Burchatz | Occupational Therapy Assistant | 415 Fourth Avenue Ne, Golden Living Center, Watertown, SD 57201 | 2013-02-12 |
| 1215292560 | Eagle Vision | Eyewear Supplier (Equipment, not the service) | 906 1/2 9th Ave Se, Watertown, SD 57201 | 2012-07-11 |
| 1669777462 | Eve Lynn Hensler | Audiologist | 405 18th Ave. Ne, Professional Hearing Services, Inc., Watertown, SD 57201 | 2011-01-26 |
| 1760792261 | Maria Redmond | Physical Therapist | 810 South Maple, Watertown, SD 57201 | 2010-10-18 |
| 1194918995 | Colette Wheeler | Occupational Therapist | 17330, 458th Ave, Watertown, SD 57201 | 2007-08-24 |
| 1861685166 | Sanford Clinic | Radiology | 891 14th Ave Ne, Watertown, SD 57201 | 2007-08-21 |
| Find all providers in zip 57201 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730793001 | Zinzendorf Hall, Inc. | Assisted Living Facility | 1047 Hill St, Watertown, WI 53098-3015 | 2020-09-03 |
| 1083089825 | Edgewood Prairie Crossings Watertown Il LLC | Assisted Living Facility | 901 14th Ave Ne, Watertown, SD 57201-6817 | 2015-12-04 |
| 1063848174 | Edgewood Prairie Crossings Watertown | Assisted Living Facility | 420 9th St Se, Watertown, SD 57201-4554 | 2013-09-20 |
| 1952604688 | Heritage Assisted Living of Watertown, LLC | Assisted Living Facility | 700 Welsh Rd, Watertown, WI 53098-4266 | 2010-12-20 |
| 1831399336 | Joyce Wendel | Assisted Living Facility | 17444 Meadow Lake Rd, Watertown, SD 57201-9181 | 2007-07-23 |
| 1598884355 | Brigham House Assisted Living | Assisted Living Facility | Brigham House, 341 Mount Auburn St, Watertown, MA 02472 | 2007-03-29 |
| 1922142785 | Good Samaritan - Sioux Valley Community Health Services | Assisted Living Facility | 424 9th St Se, Watertown, SD 57201-4554 | 2007-02-16 |
| 1619597465 | River View Platinum LLC | Assisted Living Facility | 1301 E Main St, Watertown, WI 53094-4043 | 2020-04-22 |
| 1114353224 | Edgewood Prairie Crossings Watertown, LLC | Assisted Living Facility | 424 9th St Se, Watertown, SD 57201-4554 | 2013-09-20 |
| 1003151937 | Samaritan Senior Village | Assisted Living Facility | 22691 Campus Drive, Watertown, NY 13601 | 2012-12-04 |
| Find all providers in WATERTOWN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.