MEDICARE: EDGEWOOD CONVALESCENT HOME INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	S0082	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306064639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGEWOOD CONVALESCENT HOME INC

Provider Business Mailing Address
First Line	:	302 W LINCOLN ST
Second Line	:
City	:	EDGEWOOD
State	:	IA
Zip	:	52042-8735
Country	:	US
Telephone Number	:	563-928-7173
Fax Number	:	563-928-6462

Provider Business Practice Location Address
First Line	:	302 W LINCOLN
Second Line	:
City	:	EDGEWOOD
State	:	IA
Zip	:	52042-0039
Country	:	US
Telephone Number	:	563-928-7173
Fax Number	:	563-928-6462

Authorized Official
Title or Position	:	BOARD SECRETARY/TREASURER
Name	:	KRISTEN ARTHUR
Credential	:
Telephone Number	:	563-928-6461

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	05/19/2026

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