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Newly Listed Provider — this NPI profile has been added to the NPI registry within the last 90 days.

EDGEWOOD KINGMAN AZ03 LLC
NPI 1366376683
Assisted Living Facility in Kingman, AZ

Active since June 11, 2026
3600 PETERSON RD, KINGMAN, AZ 86409(928) 451-7951 Get Directions Write a Review

NPPES record added: June 11, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Edgewood Kingman Az03 Llc NPPES

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

EDGEWOOD KINGMAN AZ03 LLC (NPI 1366376683), doing business as Avista Senior Living White Cliffs, is a healthcare organization registered as an assisted living facility in Kingman, Arizona and active in the NPI registry since June 2026. The organization lists John Dybwad, Vp Finance/budget, as its authorized official.

NPPES Registry Identity

NPI1366376683
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD KINGMAN AZ03 LLC
Location Address3600 PETERSON RDKingman, AZ 86409-3276
Mailing AddressPo Box 13238Grand Forks, ND 58208-3238 · (701) 738-2000 · Fax (701) 738-2000
Phone(928) 451-7951
Organization SubpartNo
Authorized OfficialJohn DybwadVp Finance/budget · (701) 738-2000
Enumeration DateJune 11, 2026
NPPES CertifiedJune 11, 2026
✔ NPI 1366376683 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
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.
3600 PETERSON RD, Kingman, AZ 86409
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Other Names 1

Doing Business AsAvista Senior Living White Cliffs

Other Providers at the Same Location NPPES

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

KINGMAN SENIOR LIVING, LLC
Assisted Living Facility
3600 PETERSON RD
KINGMAN, AZ 86409
Mohave County (928) 681-1050

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 Kingman Az03 LLC's NPI number?

The NPI number for Edgewood Kingman Az03 LLC is 1366376683. It was assigned to this organization in the NPPES registry on June 11, 2026. The provider is doing business as Avista Senior Living White Cliffs.

Where is Edgewood Kingman Az03 LLC located?

Edgewood Kingman Az03 LLC is located at 3600 Peterson Rd, Kingman, AZ 86409. The listed phone number is (928) 451-7951.

What is Edgewood Kingman Az03 LLC's specialty?

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

When was this NPI record last updated?

The NPPES record for Edgewood Kingman Az03 LLC was last updated on June 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 58 days 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.