NPI 1063840353

Edgewood Fruitland Senior Living LLC

Organisation Assisted Living Facility Fruitland, ID

Practice location

Address: 1255 Allen Ave, Fruitland, ID 83619-2704
Phone: (208) 452-5163
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

Other Assisted Living Facility providers in Idaho →

Registry record

NPI: 1063840353
Entity type: Organization
NPI issued: 23 Oct 2013
Record last updated: 19 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.