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EDGEWOOD HERMANTOWN 1 SENIOR LIVING LLC
NPI 1699189381
Assisted Living Facility in Hermantown, MN

Active since June 20, 2014CLIA 24D1059380 · Waiver
4175 WESTBERG RD, HERMANTOWN, MN 55811(218) 723-8905(218) 723-4051 Get Directions Write a Review

NPPES record last updated: June 20, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Edgewood Hermantown 1 Senior Living Llc NPPES

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

EDGEWOOD HERMANTOWN 1 SENIOR LIVING LLC (NPI 1699189381) is a healthcare organization registered as an assisted living facility in Hermantown, Minnesota and active in the NPI registry since June 2014. The organization holds a CLIA Waiver certificate valid through September 27, 2026 and lists Ron Whetter, Vp Of Finance/budget, as its authorized official.

NPPES Registry Identity

NPI1699189381
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD HERMANTOWN 1 SENIOR LIVING LLC
Location Address4175 WESTBERG RDHermantown, MN 55811-3916
Mailing Address322 Demers Ave, Suite 500Grand Forks, ND 58201-4754 · (701) 757-5465 · Fax (701) 738-2001
Phone(218) 723-8905
Fax(218) 723-4051
Organization SubpartNo
Authorized OfficialRon WhetterVp Of Finance/budget · (701) 757-5465
Enumeration DateJune 20, 2014
✔ NPI 1699189381 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in MN · 363096
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.
4175 WESTBERG RD, Hermantown, MN 55811
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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 24D1059380

Edgewood Hermantown Senior Living · Hermantown, MN
Active · expires Sep 27, 2026
CLIA Number24D1059380
Laboratory TypeHome Health Agency
Certificate Effective DateSeptember 28, 2024
Certificate Expiration DateSeptember 27, 2026
Laboratory DirectorKirsten Pattison
Laboratory Phone(218) 723-8905
Laboratory LocationEdgewood Hermantown Senior Living4125 Westberg Road, Hermantown, MN 55811
CLIA data matches this NPI record on: 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 Edgewood Hermantown 1 Senior Living LLC's NPI number?

The NPI number for Edgewood Hermantown 1 Senior Living LLC is 1699189381. It was assigned to this organization in the NPPES registry on June 20, 2014.

Where is Edgewood Hermantown 1 Senior Living LLC located?

Edgewood Hermantown 1 Senior Living LLC is located at 4175 Westberg Rd, Hermantown, MN 55811. The listed phone number is (218) 723-8905.

What is Edgewood Hermantown 1 Senior Living LLC's specialty?

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

Does Edgewood Hermantown 1 Senior Living LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1059380) is associated with this NPI, valid through September 27, 2026. 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 Hermantown 1 Senior Living LLC was last updated on June 20, 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.