Healthcare Provider Details

I. General information

NPI: 1386178994
Provider Name (Legal Business Name): EDGEWOOD MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 DEMERS AVE SUITE 500
GRAND FORKS ND
58201-4754
US

IV. Provider business mailing address

322 DEMERS AVE SUITE 500
GRAND FORKS ND
58201-4754
US

V. Phone/Fax

Practice location:
  • Phone: 701-738-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PHILIP GISI
Title or Position: CEO
Credential:
Phone: 701-741-6230