EDENCREST AT KETTLESTONE, LLC
NPI 1215822366
Assisted Living Facility in Waukee, IA
About Edencrest At Kettlestone, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
EDENCREST AT KETTLESTONE, LLC (NPI 1215822366) is a healthcare organization registered as an assisted living facility in Waukee, Iowa and active in the NPI registry since June 2025. The organization holds a CLIA Waiver certificate valid through May 30, 2028 and lists Susan Cunningham, Director Of Wellness, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
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 16D2305489
Edencrest At Kettlestone · Waukee, IAFrequently 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 Edencrest At Kettlestone, LLC's NPI number?
The NPI number for Edencrest At Kettlestone, LLC is 1215822366. It was assigned to this organization in the NPPES registry on June 10, 2025.
Where is Edencrest At Kettlestone, LLC located?
Edencrest At Kettlestone, LLC is located at 805 SE Tallgrass Ln, Waukee, IA 50263. The listed phone number is (515) 498-5380.
What is Edencrest At Kettlestone, LLC's specialty?
The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.
Does Edencrest At Kettlestone, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 16D2305489) is associated with this NPI, valid through May 30, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Edencrest At Kettlestone, LLC was last updated on June 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.
# Edencrest At Kettlestone, Llc · NPI 1215822366
Assisted Living Facility organization in Waukee, Iowa. Organization record, active in the CMS NPPES registry since June 10, 2025.
## Identity
- **NPI:** 1215822366 (Entity type: Organization)
- **Enumerated:** June 10, 2025
- **Primary specialty:** Assisted Living Facility · taxonomy 310400000X
- **Also known as:** Edencrest at Kettlestone, LLC (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Susan Cunningham, DIRECTOR OF WELLNESS
## Practice location
- **Address:** 805 SE TALLGRASS LN, Waukee, IA 50263-6819
- **Phone:** (515) 498-5380
## Record status
- **NPPES last updated:** June 13, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1215822366) · Data from the CMS NPPES public registry.