1. Home
  2. Directory
  3. Minnesota
  4. Edgerton
  5. Assisted Living Facility
  6. NPI Profile

EDGEBROOK ESTATES ASSISTED LIVING
NPI 1548588957
Assisted Living Facility in Edgerton, MN

Active since May 10, 2010CLIA 24D1042990 · Waiver
301 5TH AVE N, EDGERTON, MN 56128(507) 442-5080(507) 442-5101 Get Directions Write a Review

NPPES record last updated: May 10, 2010. Verified against the NPPES registry weekly; last sync: September 06, 2026.

About Edgebrook Estates Assisted Living NPPES

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

EDGEBROOK ESTATES ASSISTED LIVING (NPI 1548588957) is a healthcare organization registered as an assisted living facility in Edgerton, Minnesota and active in the NPI registry since May 2010. The organization holds a CLIA Waiver certificate valid through July 12, 2027 and lists Philip Samuelson, Administrator, as its authorized official.

NPPES Registry Identity

NPI1548588957
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEBROOK ESTATES ASSISTED LIVING
Location Address301 5TH AVE NEdgerton, MN 56128-1298
Mailing Address505 Trosky Rd WEdgerton, MN 56128-2748 · (507) 442-7121 · Fax (507) 442-3952
Phone(507) 442-5080
Fax(507) 442-5101
Organization SubpartYesParent: Edgebrook Care Center
Authorized OfficialPhilip SamuelsonAdministrator · (507) 442-7121
Enumeration DateMay 10, 2010
✔ NPI 1548588957 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 · 344559✔ Licensed in MN · 344300
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.
301 5TH AVE N, Edgerton, MN 56128
Open in Google Maps ↗

Other Identifiers 1

Medicaid7122419MN

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 24D1042990

Edgebrook Estates Assisted Living · Edgerton, MN
Active · expires Jul 12, 2027
CLIA Number24D1042990
Laboratory TypeAssisted Living Facility
Certificate Effective DateJuly 13, 2025
Certificate Expiration DateJuly 12, 2027
Laboratory DirectorTara Wiekeraad
Laboratory Phone(507) 442-7121
Laboratory LocationEdgebrook Estates Assisted Living301 5th Ave N, Edgerton, MN 56128
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Edgebrook Estates Assisted Living's NPI number?

The NPI number for Edgebrook Estates Assisted Living is 1548588957. It was assigned to this organization in the NPPES registry on May 10, 2010.

Where is Edgebrook Estates Assisted Living located?

Edgebrook Estates Assisted Living is located at 301 5th Ave N, Edgerton, MN 56128. The listed phone number is (507) 442-5080.

What is Edgebrook Estates Assisted Living's specialty?

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

Does Edgebrook Estates Assisted Living hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1042990) is associated with this NPI, valid through July 12, 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 Edgebrook Estates Assisted Living was last updated on May 10, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.