Healthcare Provider Details

I. General information

NPI: 1346564689
Provider Name (Legal Business Name): EDGEWOOD RETIREMENT COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 01/20/2012
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES ROSENMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 978-725-4102