Organization
EDGEWOOD SPRING CREEK EAGLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DYBWAD (VP OF FINANCE)
(701) 757-5422
Entity
Organization
Contact information
Practice address
653 N EAGLE RD, EAGLE, ID 83616-6921
(208) 938-5578
(208) 938-1589
Mailing address
PO BOX 13238, GRAND FORKS, ND 58208
(701) 738-2000
(208) 350-6761
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
RC-1007
ID
Other
Enumeration date
10/20/2011
Last updated
08/18/2022
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