Organization
EDGEWOOD PLANTATION PLACE 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
3921 KESSINGER LN, BOISE, ID 83703-3003
(208) 853-7300
(208) 853-9328
Mailing address
PO BOX 13238, GRAND FORKS, ND 58208
(701) 738-2000
(208) 853-9328
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
83703
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A0000774
—
ID
Enumeration date
07/06/2011
Last updated
08/18/2022
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