EDGEWOOD BRAINERD SENIOR LIVING LLC (NPI# 1205010147) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205010147 |
| Entity Type | Organization |
| Organization Name | EDGEWOOD BRAINERD SENIOR LIVING LLC |
| Practice Address |
14890 Beaver Dam Rd Brainerd MN 56401-6019 |
| Mailing Address |
2850 24th Ave S Suite 201 Grand Forks ND 58201-5831 |
| Practice Telephone | 7017382000 |
| Practice Fax Number | 7017382001 |
| Mailing Telephone | 7017382000 |
| Mailing Fax Number | 7017382001 |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2007-12-27 |
| Authorized Official Name | GENE HYSJULIEN (CEO) |
| Authorized Official Telephone | 7017382000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 338402 | MN | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 338393 | 05 |
| Street Address |
14890 BEAVER DAM RD |
| City | BRAINERD |
| State | MN |
| Zip Code | 56401-6019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356494520 | Edgewood Vista | Assisted Living Facility | 14890 Beaver Dam Rd, Brainerd, MN 56401-6019 | 2007-01-19 |
| 1831662154 | Kristen Elliott | Speech-Language Pathologist | 14890 Beaver Dam Rd, Brainerd, MN 56401-6019 | 2019-01-09 |
| 1225506413 | Laura Melin | Physical Therapist | 14890 Beaver Dam Rd, Brainerd, MN 56401-6019 | 2018-11-06 |
| 1841775194 | Caringedge Hospice of Brainerd | Hospice Care, Community Based | 14890 Beaver Dam Rd, Brainerd, MN 56401-6019 | 2018-10-02 |
| 1225513674 | Caringedge Healthcare of Brainerd | Home Health | 14890 Beaver Dam Rd, Brainerd, MN 56401-6019 | 2018-10-02 |
| 1912212820 | Laura Amundson | Occupational Therapist | 14890 Beaver Dam Rd, Brainerd, MN 56401 | 2010-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396222832 | Nicholas James Manning | Physical Therapist | 7350 Clearwater Rd N, Baxter, MN 56401 | 2018-07-27 |
| 1952819757 | Hannah Marie Darabi | Physical Therapist | Essentia Health Rehabilitation Services, 2016 South Sixth Street, Brainer, MN 56401 | 2018-01-15 |
| 1154867406 | Nancy Ann Schauer | Social Worker | 823 Maple Street, Northern Pine Mental Health Center, Brainerd, MN 56401 | 2017-01-10 |
| 1336530310 | Audrey Jean Twit | Pharmacist | 523 North Third Street, Essentia Health St Joseph's Medical Center, Brainerd, MN 56401 | 2015-02-11 |
| 1245638584 | The Renneke Chiropractic Clinic | Physical Therapist | 623 Madison St., Brainerd, MN 56401 | 2014-12-19 |
| 1124420179 | Jenna Niggeler | Acupuncturist | 1001 Kingwood St Ste 119a, Brainerd, MN 56401 | 2014-09-22 |
| 1073933719 | Nicholas Adam Lesmeister | Orthopaedic Surgery | 2014 South 6th Street, Brainerd, MN 56401 | 2014-04-21 |
| 1073864666 | Jennifer L. Owens | Marriage & Family Therapist | 4706 Wilderness Ct Ste 101, Brainerd, MN 56401 | 2012-09-24 |
| 1619297447 | Christine Elaine Smalling | Licensed Practical Nurse | 6317 Estate Circle Drive, Brainerd, MN 56401 | 2010-06-03 |
| 1528241577 | Dannia Lor Vang | Pharmacist | 2024 South 6th St, Clinic Pharmacy, Brainerd, MN 56401 | 2007-12-13 |
| Find all providers in zip 56401 | ||||
| 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 |
|---|---|---|---|---|
| 1790103943 | The Evangelical Lutheran Good Samaritan Society | Assisted Living Facility | 1953 S 7th St, Brainerd, MN 56401-4575 | 2014-04-04 |
| 1609294859 | The Evangelical Lutheran Good Samaritan Society | Assisted Living Facility | 200 Buffalo Hills Ln, Brainerd, MN 56401-4555 | 2014-04-04 |
| 1356494520 | Edgewood Vista | Assisted Living Facility | 14890 Beaver Dam Rd, Brainerd, MN 56401-6019 | 2007-01-19 |
| 1629176383 | The Evangelical Lutheran Good Samaritan Society | Assisted Living Facility | 2509 Greenwood St Sw, Brainerd, MN 56401-8340 | 2006-09-20 |
| 1013011253 | The Evangelical Lutheran Good Samaritan Society | Assisted Living Facility | 2517 Greenwood St Sw, Brainerd, MN 56401-8340 | 2006-09-08 |
| 1487757852 | The Evangelical Lutheran Good Samaritan Society | Assisted Living Facility | 2501 Greenwood St Sw, Brainerd, MN 56401-8340 | 2006-09-07 |
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| 1750980603 | Estherra Care LLC | Assisted Living Facility | 1120 Morgan Ave N, Minneapolis, MN 55411-3805 | 2020-10-21 |
| 1679189682 | Daniel Care Homes LLC | Assisted Living Facility | 6809 Perry Ave N, Brooklyn Center, MN 55429-1611 | 2020-09-16 |
| 1326651779 | Secured Health and Homecare Inc | Assisted Living Facility | 4519 104th Ave N, Brooklyn Park, MN 55443-1030 | 2020-08-26 |
| 1811509870 | Aurora Assisted Living LLC | Assisted Living Facility | 115 Magnolia Ave W, Saint Paul, MN 55117-4916 | 2020-08-20 |
| 1003427477 | In My Father's House | Assisted Living Facility | 3096 Snelling Ave N, Roseville, MN 55113-1659 | 2020-08-11 |
| 1710595863 | Eden Prairie Senior Living | Assisted Living Facility | 8480 Franlo Rd, Eden Prairie, MN 55344-2938 | 2020-07-15 |
| 1447868468 | Brightstar Services LLC | Assisted Living Facility | 1821 University Ave W Ste 120, Saint Paul, MN 55104-2811 | 2020-07-15 |
| 1235757667 | Roers Senior Living Buffalo LLC | Assisted Living Facility | 150 Division Street East, Buffalo, MN 55313 | 2020-07-13 |
| Find all providers with the same taxonomy | ||||
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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.