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EDGEWOOD BLAINE LLC
NPI 1396167953
Assisted Living Facility in Blaine, MN

Active since January 15, 2014CLIA 24D2067609 · Waiver
12450 CLOUD DR NE, BLAINE, MN 55449(763) 754-1723(763) 754-1728 Get Directions Write a Review

NPPES record last updated: January 15, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Edgewood Blaine Llc NPPES

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

EDGEWOOD BLAINE LLC (NPI 1396167953) is a healthcare organization registered as an assisted living facility in Blaine, Minnesota and active in the NPI registry since January 2014. The organization holds a CLIA Waiver certificate valid through October 20, 2027 and lists Ronald Dale Whetter, Vp Of Finance/budget, as its authorized official.

NPPES Registry Identity

NPI1396167953
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD BLAINE LLC
Location Address12450 CLOUD DR NEBlaine, MN 55449-6226
Mailing Address322 Demers Ave, Suite 500Grand Forks, ND 58201-4754 · (701) 757-5465
Phone(763) 754-1723
Fax(763) 754-1728
Organization SubpartNo
Authorized OfficialRonald Dale WhetterVp Of Finance/budget · (701) 757-5465
Enumeration DateJanuary 15, 2014
✔ NPI 1396167953 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 MN · 29791✔ Licensed in MN · 29941
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.
12450 CLOUD DR NE, Blaine, MN 55449
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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 24D2067609

Edgewood Blaine Senior Living, LLC · Blaine, MN
Active · expires Oct 20, 2027
CLIA Number24D2067609
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 21, 2025
Certificate Expiration DateOctober 20, 2027
Laboratory DirectorStacy April
Laboratory Phone(218) 230-5019
Laboratory LocationEdgewood Blaine Senior Living, LLC12450 Cloud Drive NE, Blaine, MN 55449
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 5

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

TRACY SPITZACK SLP
Speech-Language Pathologist
12450 CLOUD DR NE
BLAINE, MN 55449
Anoka County (763) 777-7117
CHELSEY MARIE JOY WEINTRAUB
Occupational Therapist
12450 CLOUD DR NE
BLAINE, MN 55449
Anoka County (763) 777-7117
STEPHANIE LYNN MOLLINGER DPT
Physical Therapist
12450 CLOUD DR NE
BLAINE, MN 55449
Anoka County (763) 777-7117
JESSICA KOPP
Occupational Therapist
12450 CLOUD DR NE
BLAINE, MN 55449
Anoka County (763) 777-7117
CHRISTINE TAKES DPT
Physical Therapist
12450 CLOUD DR NE
BLAINE, MN 55449
Anoka County (763) 777-7117

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 Blaine LLC's NPI number?

The NPI number for Edgewood Blaine LLC is 1396167953. It was assigned to this organization in the NPPES registry on January 15, 2014.

Where is Edgewood Blaine LLC located?

Edgewood Blaine LLC is located at 12450 Cloud Dr NE, Blaine, MN 55449. The listed phone number is (763) 754-1723.

What is Edgewood Blaine LLC's specialty?

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

Does Edgewood Blaine LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2067609) is associated with this NPI, valid through October 20, 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 Blaine LLC was last updated on January 15, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.