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EDGEWATER, A WESLEY ACTIVE LIFE COMMUNITY, LLC

>> Skilled Nursing Facility >> Nursing & Custodial Care Facilities

Registrant NPI Number: 1154560506

Organizational Registrant:
Organization Name:  EDGEWATER, A WESLEY ACTIVE LIFE COMMUNITY, LLC
Organization is Subpart
Authorized Official:  FRANK  TALLERICO  CFO  515--27-16559

Location and contact information for practice:
9225 CASCADE  WEST DES MOINES, IA 50266 US
Tel: 515-978-2395  Fax: 515-271-6898

Contact information for business:
5508 NW 88TH ST  JOHNSTON, IA 50131-3005 US
Tel: 515-978-2395  Fax: 515-271-6898

Registration Information:
NPI: 1154560506
Entity Type: Organization

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y314000000XNursing & Custodial Care Facilities
Skilled Nursing Facility

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
0800031IA05




HEALTH CARE JOBS IA - Page 1



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