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Contact Information

EDGEBROOK CARE CENTER
505 W TROSKY RD
EDGERTON, MN56128-2748
 Phone: 507-442-7121
 Fax: 507-442-3952
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Nursing Facility Supplies

332BN1400X 87 All Other Suppliers
 

Parenteral & Enteral Nutrition

332BP3500X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for EDGEBROOK CARE CENTER

NPI # 1003893447
LBN Legal business name EDGEBROOK CARE CENTER
Authorized official JOHN DOUGHTY - (ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/28/2005
Last updated 12/28/2012 - About 13 years ago
Identifiers
MN Medicaid 767842800
MN Other 9508ED BCBS
MN Other 7122565 EVERCARE-MEDICA
MN Other 030824003 PRIME WEST
MN Other NH0481 UCARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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