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EDGEWOOD MANDAN, LLC
NPI 1306243647
Assisted Living Facility in Mandan, ND

Active since December 02, 2014CLIA 35D2067476 · Waiver
2801 39TH AVE SE, MANDAN, ND 58554(701) 663-5664 Get Directions Write a Review

NPPES record last updated: December 2, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Edgewood Mandan, Llc NPPES

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

EDGEWOOD MANDAN, LLC (NPI 1306243647) is a healthcare organization registered as an assisted living facility in Mandan, North Dakota and active in the NPI registry since December 2014. The organization holds a CLIA Waiver certificate valid through October 15, 2027 and lists Ron Whetter, Vp Finance/budget, as its authorized official.

NPPES Registry Identity

NPI1306243647
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD MANDAN, LLC
Location Address2801 39TH AVE SEMandan, ND 58554-6430
Mailing Address322 Demers Ave, Suite 500Grand Forks, ND 58201-4754 · (218) 230-5953
Phone(701) 663-5664
Organization SubpartNo
Authorized OfficialRon WhetterVp Finance/budget · (218) 230-5953
Enumeration DateDecember 2, 2014
✔ NPI 1306243647 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Licenses✔ Licensed in ND · AL68✔ Licensed in ND · 88
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.
2801 39TH AVE SE, Mandan, ND 58554
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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 35D2067476

Edgewood Mandan Senior Living, LLC · Mandan, ND
Active · expires Oct 15, 2027
CLIA Number35D2067476
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 16, 2025
Certificate Expiration DateOctober 15, 2027
Laboratory DirectorJaiden Bennett
Laboratory Phone(701) 391-5777
Laboratory LocationEdgewood Mandan Senior Living, LLC2801 39th Ave SE, Mandan, ND 58554
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 2

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

SAMANTHA FORSTER DPT
Physical Therapist
2801 39TH AVE SE
MANDAN, ND 58554
Morton County (701) 751-3001
DR. COURTNEY NICOLE LEDGER PT, DPT
Physical Therapist
2801 39TH AVE SE
MANDAN, ND 58554
Morton County (701) 663-5664

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 Mandan, LLC's NPI number?

The NPI number for Edgewood Mandan, LLC is 1306243647. It was assigned to this organization in the NPPES registry on December 2, 2014.

Where is Edgewood Mandan, LLC located?

Edgewood Mandan, LLC is located at 2801 39th Ave SE, Mandan, ND 58554. The listed phone number is (701) 663-5664.

What is Edgewood Mandan, LLC's specialty?

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

Does Edgewood Mandan, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 35D2067476) is associated with this NPI, valid through October 15, 2027. 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 Mandan, LLC was last updated on December 2, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.