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EDGEWOOD LAKEWOOD MANDAN LLC
NPI 1386469021
Alzheimer Center (Dementia Center) in Mandan, ND

Active since November 18, 2024CLIA 35D2316987 · Waiver
4401 21ST ST SE, MANDAN, ND 58554(701) 738-2000(701) 738-2001 Get Directions Write a Review

NPPES record last updated: February 12, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Feb 12, 2025, Nov 18, 2024 (2 updates tracked since 2024).

About Edgewood Lakewood Mandan Llc NPPES

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

EDGEWOOD LAKEWOOD MANDAN LLC (NPI 1386469021) is a healthcare organization registered as an alzheimer center (dementia center) in Mandan, North Dakota and active in the NPI registry since November 2024. The organization holds a CLIA Waiver certificate valid through January 15, 2027 and lists John Dybwad, Vp Finance/budget, as its authorized official.

NPPES Registry Identity

NPI1386469021
Entity TypeOrganization
Primary Taxonomy311500000X
Legal Business NameEDGEWOOD LAKEWOOD MANDAN LLC
Location Address4401 21ST ST SEMandan, ND 58554-6425
Mailing AddressPo Box 13238Grand Forks, ND 58208-3238 · (701) 738-2000 · Fax (701) 738-2001
Phone(701) 738-2000
Fax(701) 738-2001
Organization SubpartNo
Authorized OfficialJohn DybwadVp Finance/budget · (701) 738-2000
Enumeration DateNovember 18, 2024
Last NPPES UpdateFebruary 12, 20252 updates tracked since enumeration
NPPES CertifiedFebruary 12, 2025
✔ NPI 1386469021 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAlzheimer Center (Dementia Center)Nursing & Custodial Care Facilities
Taxonomy Code311500000X
Definition
A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer's Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations.
Also ListedIn Home Supportive CareTaxonomy 253Z00000X
4401 21ST ST SE, Mandan, ND 58554
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Other Names 1

Other NameEdgewood Healthcare

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 35D2316987

Edgewood Lakewood Mandan LLC · Mandan, ND
Active · expires Jan 15, 2027
CLIA Number35D2316987
Laboratory TypeAssisted Living Facility
Certificate Effective DateJanuary 16, 2025
Certificate Expiration DateJanuary 15, 2027
Laboratory DirectorGabriell Petri-Hancock
Laboratory Phone(701) 738-2000
Laboratory LocationEdgewood Lakewood Mandan LLC4401 21st St SE, Mandan, ND 58554
CLIA data matches this NPI record on: Address Name Phone
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.

LAKEWOOD LANDING, INC.
Assisted Living Facility
4401 21ST ST SE
MANDAN, ND 58554
Morton County (701) 751-6191
EDGEWOOD LAKEWOOD MANDAN, LLC
Assisted Living Facility
4401 21ST ST SE
MANDAN, ND 58554
Morton County (701) 738-2000

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 Lakewood Mandan LLC's NPI number?

The NPI number for Edgewood Lakewood Mandan LLC is 1386469021. It was assigned to this organization in the NPPES registry on November 18, 2024. The provider is also known as Edgewood Healthcare.

Where is Edgewood Lakewood Mandan LLC located?

Edgewood Lakewood Mandan LLC is located at 4401 21st St SE, Mandan, ND 58554. The listed phone number is (701) 738-2000.

What is Edgewood Lakewood Mandan LLC's specialty?

The primary specialty registered for this NPI is Alzheimer Center (Dementia Center) with taxonomy code 311500000X.

Does Edgewood Lakewood Mandan LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 35D2316987) is associated with this NPI, valid through January 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 Lakewood Mandan LLC was last updated on February 12, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.