NPI 1114383577

Edgewood Spring Creek Eagle Island LLC

Organisation Assisted Living Facility Boise, ID

Practice location

Address: 12426 W Explorer Dr STE 220, Boise, ID 83713-1560
Phone: (208) 947-4012
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 RC1104 (ID)

Other Assisted Living Facility providers in Idaho →

Registry record

NPI: 1114383577
Entity type: Organization
NPI issued: 14 Jan 2016
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.