EDGEWOOD HERMANTOWN II SENIOR LIVING LLC
NPI 1083898860
Assisted Living Facility in Hermantown, MN

Q: What is Edgewood Hermantown II Senior Living LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Active since December 28, 2007CLIA 24D1034577 · Waiver

4125 WESTBERG RD, HERMANTOWN, MN 55811(701) 738-2000(701) 738-2001 Get Directions Write a Review

NPPES record last updated: May 26, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Edgewood Hermantown Ii Senior Living Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDGEWOOD HERMANTOWN II SENIOR LIVING LLC (NPI 1083898860) is a healthcare organization registered as an assisted living facility in Hermantown, Minnesota and active in the NPI registry since December 2007. The organization holds a CLIA Waiver certificate valid through December 6, 2026 and lists Ron Whetter, Vp Budget And Finance, as its authorized official.

NPPES Registry Identity

NPI1083898860

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameEDGEWOOD HERMANTOWN II SENIOR LIVING LLC

Location Address4125 WESTBERG RDHermantown, MN 55811-3923

Mailing Address2850 24th Ave S, Suite 201Grand Forks, ND 58201-5831 · (701) 738-2000 · Fax (701) 738-2001

Phone(701) 738-2000

Fax(701) 738-2001

Organization SubpartNo

Authorized OfficialRon WhetterVp Budget And Finance · (701) 738-2000

Enumeration DateDecember 28, 2007

Last NPPES UpdateMay 26, 2011

✔ NPI 1083898860 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

License✔ Licensed in MN · 338365

Definition

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.

4125 WESTBERG RD, Hermantown, MN 55811

Open in Google Maps ↗

Other Identifiers 1

Medicaid338365MN

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D1034577

Edgewood Hermantown II Senior Living LLC · Hermantown, MN

Active · expires Dec 6, 2026

CLIA Number24D1034577

Laboratory TypeAssisted Living Facility

Certificate Effective DateDecember 7, 2024

Certificate Expiration DateDecember 6, 2026

Laboratory DirectorJodi Dianoski

Laboratory Phone(218) 740-6000

Laboratory LocationEdgewood Hermantown II Senior Living LLC4195 Westburg Road, Hermantown, MN 55811

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Edgewood Hermantown II Senior Living LLC's NPI number?

The NPI number for Edgewood Hermantown II Senior Living LLC is 1083898860. It was assigned to this organization in the NPPES registry on December 28, 2007.

Where is Edgewood Hermantown II Senior Living LLC located?

Edgewood Hermantown II Senior Living LLC is located at 4125 Westberg Rd, Hermantown, MN 55811. The listed phone number is (701) 738-2000.

What is Edgewood Hermantown II Senior Living LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Edgewood Hermantown II Senior Living LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1034577) is associated with this NPI, valid through December 6, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Edgewood Hermantown II Senior Living LLC was last updated on May 26, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.