Organization
EDGEWOOD SPRING CREEK BOISE, 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
10681 MCMILLAN RD, BOISE, ID 83713-2628
(208) 954-5660
Mailing address
PO BOX 13238, GRAND FORKS, ND 58208
(701) 738-2000
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
RC1006
ID
Other
Enumeration date
09/27/2011
Last updated
08/19/2022
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