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EDGEWOOD BRAINERD SENIOR LIVING LLC
NPI 1205010147
Assisted Living Facility in Brainerd, MN

Active since December 27, 2007CLIA 24D1058401 · Waiver
14890 BEAVER DAM RD, BRAINERD, MN 56401(701) 738-2000(701) 738-2001 Get Directions Write a Review

NPPES record last updated: December 27, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Edgewood Brainerd Senior Living Llc NPPES

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

EDGEWOOD BRAINERD SENIOR LIVING LLC (NPI 1205010147) is a healthcare organization registered as an assisted living facility in Brainerd, Minnesota and active in the NPI registry since December 2007. The organization holds a CLIA Waiver certificate valid through September 5, 2026 and lists Gene Hysjulien, Ceo, as its authorized official.

NPPES Registry Identity

NPI1205010147
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD BRAINERD SENIOR LIVING LLC
Location Address14890 BEAVER DAM RDBrainerd, MN 56401-6019
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 OfficialGene HysjulienCeo · (701) 738-2000
Enumeration DateDecember 27, 2007
✔ NPI 1205010147 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 · 338402
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.
14890 BEAVER DAM RD, Brainerd, MN 56401
Open in Google Maps ↗

Other Identifiers 1

Medicaid338393MN

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 24D1058401

Edgewood Brainerd Senior Living LLC · Brainerd, MN
Active · expires Sep 5, 2026
CLIA Number24D1058401
Laboratory TypeOther
Certificate Effective DateSeptember 6, 2024
Certificate Expiration DateSeptember 5, 2026
Laboratory DirectorJesse Noska
Laboratory Phone(218) 828-3691
Laboratory LocationEdgewood Brainerd Senior Living LLC14890 Beaver Dam Road, Brainerd, MN 56401
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAURA MELIN DPT
Physical Therapist
14890 BEAVER DAM RD
BRAINERD, MN 56401
Crow Wing County (218) 297-1605
KRISTEN ELLIOTT SLP
Speech-Language Pathologist
14890 BEAVER DAM RD
BRAINERD, MN 56401
Crow Wing County (218) 297-1605
LAURA AMUNDSON OTR/L
Occupational Therapist
14890 BEAVER DAM RD
BRAINERD, MN 56401
Crow Wing County (218) 297-1605

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 Brainerd Senior Living LLC's NPI number?

The NPI number for Edgewood Brainerd Senior Living LLC is 1205010147. It was assigned to this organization in the NPPES registry on December 27, 2007.

Where is Edgewood Brainerd Senior Living LLC located?

Edgewood Brainerd Senior Living LLC is located at 14890 Beaver Dam Rd, Brainerd, MN 56401. The listed phone number is (701) 738-2000.

What is Edgewood Brainerd Senior Living LLC's specialty?

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

Does Edgewood Brainerd Senior Living LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1058401) is associated with this NPI, valid through September 5, 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 Brainerd Senior Living LLC was last updated on December 27, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.