Healthcare Provider Details

I. General information

NPI: 1659354355
Provider Name (Legal Business Name): EDGEWOOD RETIREMENT COMMUNITY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 OSGOOD ST
NORTH ANDOVER MA
01845-1975
US

IV. Provider business mailing address

575 OSGOOD ST
NORTH ANDOVER MA
01845-1975
US

V. Phone/Fax

Practice location:
  • Phone: 978-725-3300
  • Fax: 978-725-5997
Mailing address:
  • Phone: 978-725-3300
  • Fax: 978-725-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOTTG
License Number StateMA

VIII. Authorized Official

Name: MARLENE ROTERING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 978-725-3300