EDGEWOOD PRAIRIE CROSSINGS WATERTOWN IL LLC (NPI# 1083089825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083089825 |
| Entity Type | Organization |
| Organization Name | EDGEWOOD PRAIRIE CROSSINGS WATERTOWN IL LLC |
| Other Organization Name | EDGEWOOD THE COMMONS |
| Practice Address |
901 14th Ave Ne Watertown SD 57201-6817 |
| Mailing Address |
322 Demers Ave Ste 500 Grand Forks ND 58201-4799 |
| Practice Telephone | 6058823084 |
| Mailing Telephone | 7017575410 |
| Enumeration Date | 2015-12-04 |
| Last Update Date | 2015-12-04 |
| Authorized Official Name | REX CARLSON (TREASURER) |
| Authorized Official Telephone | 7017575463 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Edgewood The Commons | Other Name - Individual/Organization |
| Street Address |
901 14TH AVE NE |
| City | WATERTOWN |
| State | SD |
| Zip Code | 57201-6817 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568022002 | Sterling Hubbard | Physical Therapist | 901 14th Ave Ne, Watertown, SD 57201-6817 | 2019-06-17 |
| 1871051961 | Lynae Petersen | Occupational Therapist | 901 14th Ave Ne, Watertown, SD 57201-6817 | 2019-03-07 |
| 1013490952 | Elizabeth Marie Nutsch | Occupational Therapist | 901 14th Ave Ne, Watertown, SD 57201-6817 | 2018-09-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245878032 | Samantha Kay Kratovil | Dietitian, Registered | 4 19th St Ne, Watertown, SD 57201 | 2019-12-12 |
| 1326516501 | Edgewood Watertown Mc 2 LLC | Assisted Living Facility | 225 14 Ave Ne, Watertown, SD 57201 | 2018-11-06 |
| 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 |
| 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 |
| 1326516501 | Edgewood Watertown Mc 2 LLC | Assisted Living Facility | 225 14 Ave Ne, Watertown, SD 57201 | 2018-11-06 |
| 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.