| Organization Name: | EDGEWOOD OMAHA SENIOR LIVING |
| NPI Number: | 1114216561 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REX CARLSON (CHIEF FINANCIAL OFFICER) |
| Mailing Address: | 17620 Poppleton Ave. Omaha |
| State: | NE US |
| Postal Code: | 681304614 |
| Phone Number: | 4023335749 |
| Fax Number: | 4026973998 |
| NPI Enumeration Date: | 04/06/2011 |
| NPI Last Update Date: | 04/06/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 311500000X |
| License Number: | 2801060340 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Alzheimer Center (Dementia Center) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer |