EDGEWOOD VIRGINIA I SENIOR LIVING LLC
NPI 1508040395
Assisted Living Facility in Virginia, MN

Q: What is Edgewood Virginia I Senior Living LLC's specialty?

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

Active since December 28, 2007CLIA 24D1037026 · Waiver

705 17TH ST N, VIRGINIA, MN 55792(701) 738-2000(701) 738-2001 Get Directions Write a Review

NPPES record last updated: December 28, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Edgewood Virginia I Senior Living Llc NPPES

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

EDGEWOOD VIRGINIA I SENIOR LIVING LLC (NPI 1508040395) is a healthcare organization registered as an assisted living facility in Virginia, Minnesota and active in the NPI registry since December 2007. The organization holds a CLIA Waiver certificate valid through February 13, 2027 and lists Gene Hysjulien, Ceo, as its authorized official.

NPPES Registry Identity

NPI1508040395

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameEDGEWOOD VIRGINIA I SENIOR LIVING LLC

Location Address705 17TH ST NVirginia, MN 55792-2176

Mailing Address2850 24th Ave S, Suite 201Grand Forks, ND 58201-5831 · (701) 738-2000 · Fax (701) 738-2001

Phone(701) 738-2000

Fax(701) 738-2001

Organization SubpartNo

Authorized OfficialGene HysjulienCeo · (701) 738-2000

Enumeration DateDecember 28, 2007

✔ NPI 1508040395 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

Licenses✔ Licensed in MN · 338389✔ Licensed in MN · 338401

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.

Also ListedAlzheimer Center (Dementia Center)Taxonomy 311500000X · License 338390 (MN)

705 17TH ST N, Virginia, MN 55792

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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 24D1037026

Edgewood Virginia I Senior Living LLC · Virginia, MN

Active · expires Feb 13, 2027

CLIA Number24D1037026

Laboratory TypeAssisted Living Facility

Certificate Effective DateFebruary 14, 2025

Certificate Expiration DateFebruary 13, 2027

Laboratory DirectorHannah Kovatovich

Laboratory Phone(218) 741-7106

Laboratory LocationEdgewood Virginia I Senior Living LLC705 17th St North, Virginia, MN 55792

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 6

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

KATIE MERCHANT

Physical Therapist