Provider Demographics
NPI:1154560506
Name:EDGEWATER, A WESLEY ACTIVE LIFE COMMUNITY, LLC
Entity type:Organization
Organization Name:EDGEWATER, A WESLEY ACTIVE LIFE COMMUNITY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-271-6559
Mailing Address - Street 1:5508 NW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-3005
Mailing Address - Country:US
Mailing Address - Phone:515-978-2395
Mailing Address - Fax:515-271-6898
Practice Address - Street 1:9225 CASCADE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-978-2395
Practice Address - Fax:515-271-6898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESLEY RETIREMENT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-09
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0800031Medicaid
IA0800031Medicaid
IA165597Medicare Oscar/Certification