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General NPI Number Information
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NPI Number | 1013841337
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Entity Type | Organization
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Legal Business Name | EDGEWOOD BULLHEAD CITY AZ01 LLC
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 2995 DESERT SKY BLVD
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8855
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Country | US
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Telephone | 928-582-9271
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13238
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City | GRAND FORKS
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State | ND
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Zip | 58208-3238
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Country | US
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Telephone | 701-738-2000
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Fax | 701-738-2001
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Authorized Official
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Title or Position | VP FINANCE/BUDGET
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Name | JOHN DYBWAD
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Credential |
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Telephone | 701-738-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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