NPI 1225313737

Edgewood Spring Creek Ustick, LLC

Organisation Assisted Living Facility Meridian, ID

Practice location

Address: 3165 Meridian Rd, Meridian, ID 83646
Phone: (208) 287-2064
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 RC1004 (ID)

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Registry record

NPI: 1225313737
Entity type: Organization
NPI issued: 15 Oct 2011
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.