NPI 1003191149

Edgewood Spring Creek Eagle, LLC

Organisation Assisted Living Facility Eagle, ID

Practice location

Address: 653 N Eagle Rd, Eagle, ID 83616-6921
Phone: (208) 938-5578
Fax: (208) 938-1589
Mailing address: PO Box 13238, Grand Forks, ND 58208

Authorised official

Name: John Dybwad
Title: Vp of Finance
Phone: (701) 757-5422

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X Licence RC-1007 (ID)

Other Assisted Living Facility providers in Idaho →

Registry record

NPI: 1003191149
Entity type: Organization
NPI issued: 20 Oct 2011
Record last updated: 18 Aug 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.