Edgewood Spring Creek Eagle, LLC

NPI #1003191149 in Eagle, Idaho

Provider Information

NPI Number
1003191149
Entity Type
Organization
Organization Name
Edgewood Spring Creek Eagle, LLC
Primary Specialty
Assisted Living Facility
Enumeration Date
Oct 20, 2011
Last Updated
Aug 18, 2022

Practice Location

Address
653 N EAGLE RD
City
Eagle
State
Idaho
ZIP Code
83616-6921
Phone
(208) 938-5578

Authorized Official

Name
JOHN DYBWAD
Title
VP OF FINANCE
Phone
(701) 757-5422

Specialties & Taxonomy Codes

Specialty
Assisted Living Facility

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