| Organization Name: | EDGEWOOD BLAINE LLC |
| NPI Number: | 1396167953 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONALD DALE WHETTER (VP OF FINANCE/BUDGET) |
| Mailing Address: | 12450 Cloud Dr Ne Blaine |
| State: | MN US |
| Postal Code: | 554496226 |
| Phone Number: | 7637541723 |
| Fax Number: | 7637541728 |
| NPI Enumeration Date: | 01/15/2014 |
| NPI Last Update Date: | 01/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | 29941 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |