1. Home
  2. Directory
  3. South Dakota
  4. Rapid City
  5. Assisted Living Facility
  6. NPI Profile

EDGEWOOD RAPID CITY LLC
NPI 1972076024
Assisted Living Facility in Rapid City, SD

Active since January 10, 2019CLIA 43D2161964 · Waiver
4001 DERBY LANE, RAPID CITY, SD 57701(605) 718-3600(701) 738-2001 Get Directions Write a Review

NPPES record last updated: January 14, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jan 14, 2019, Jan 10, 2019 (2 updates tracked since 2019).

About Edgewood Rapid City Llc NPPES

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

EDGEWOOD RAPID CITY LLC (NPI 1972076024) is a healthcare organization registered as an assisted living facility in Rapid City, South Dakota and active in the NPI registry since January 2019. The organization holds a CLIA Waiver certificate valid through February 12, 2027 and lists John Dybwad, Vice President Of Finance, as its authorized official.

NPPES Registry Identity

NPI1972076024
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD RAPID CITY LLC
Location Address4001 DERBY LANERapid City, SD 57701
Mailing Address322 Demers Ave Ste 500Grand Forks, ND 58201 · (701) 757-5410 · Fax (701) 738-2001
Phone(605) 718-3600
Fax(701) 738-2001
Organization SubpartNo
Authorized OfficialJohn DybwadVice President Of Finance · (701) 757-5422
Enumeration DateJanuary 10, 2019
Last NPPES UpdateJanuary 14, 20192 updates tracked since enumeration
✔ NPI 1972076024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
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.

4001 DERBY LANE, Rapid City, SD 57701
Open in Google Maps ↗

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 43D2161964

Edgewood Rapid City LLC · Rapid City, SD
Active · expires Feb 12, 2027
CLIA Number43D2161964
Laboratory TypeAssisted Living Facility
Certificate Effective DateFebruary 13, 2025
Certificate Expiration DateFebruary 12, 2027
Laboratory DirectorMichelle Kuhn
Laboratory Phone(605) 718-3600
Laboratory LocationEdgewood Rapid City LLC4001 Derby Lane, Rapid City, SD 57701
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 Edgewood Rapid City LLC's NPI number?

The NPI number for Edgewood Rapid City LLC is 1972076024. It was assigned to this organization in the NPPES registry on January 10, 2019.

Where is Edgewood Rapid City LLC located?

Edgewood Rapid City LLC is located at 4001 Derby Lane, Rapid City, SD 57701. The listed phone number is (605) 718-3600.

What is Edgewood Rapid City LLC's specialty?

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

Does Edgewood Rapid City LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 43D2161964) is associated with this NPI, valid through February 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 Edgewood Rapid City LLC was last updated on January 14, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.