MEDICARE: EDGEWATER HEALTH CARE, 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	314000000X	Skilled Nursing Facility	940000058	CA

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	:	1629053913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGEWATER HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	25910 ACERO STE 350
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-7908
Country	:	US
Telephone Number	:	949-441-9258
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 E 4TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-1299
Country	:	US
Telephone Number	:	949-240-2423
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MARC JOHNSON
Credential	:
Telephone Number	:	949-373-8373

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	04/05/2024

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Directions to “EDGEWATER HEALTH CARE, INC. ” Practice Location

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