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EDGEWOOD SPRING CREEK EAGLE, LLC
NPI 1003191149
Assisted Living Facility in Eagle, ID

Active since October 20, 2011CLIA Certified · 4 labs
653 N EAGLE RD, EAGLE, ID 83616(208) 938-5578(208) 938-1589 Get Directions Write a Review

NPPES record last updated: August 18, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Edgewood Spring Creek Eagle, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDGEWOOD SPRING CREEK EAGLE, LLC (NPI 1003191149) is a healthcare organization registered as an assisted living facility in Eagle, Idaho and active in the NPI registry since October 2011. The organization holds 4 active CLIA laboratory certificates and lists John Dybwad, Vp Of Finance, as its authorized official.

NPPES Registry Identity

NPI1003191149
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD SPRING CREEK EAGLE, LLC
Location Address653 N EAGLE RDEagle, ID 83616-6921
Mailing AddressPo Box 13238Grand Forks, ND 58208 · (701) 738-2000 · Fax (208) 350-6761
Phone(208) 938-5578
Fax(208) 938-1589
Organization SubpartNo
Authorized OfficialJohn DybwadVp Of Finance · (701) 757-5422
Enumeration DateOctober 20, 2011
Last NPPES UpdateAugust 18, 2022
NPPES CertifiedAugust 18, 2022
✔ NPI 1003191149 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in ID · RC-1007
Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

653 N EAGLE RD, Eagle, ID 83616
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CLIA Laboratory Certificates CMS CLIA 4

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 13D2195037

Edgewood Spring Creek Eagle LLC · Eagle, ID
Active · expires Oct 5, 2026
CLIA Number13D2195037
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 6, 2024
Certificate Expiration DateOctober 5, 2026
Laboratory DirectorTory Hansen
Laboratory Phone(208) 938-5578
Laboratory LocationEdgewood Spring Creek Eagle LLC653 N Eagle Rd, Eagle, ID 83616
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 13D2195033

Edgewood Spring Creek Eagle Island LLC · Eagle, ID
Active · expires Oct 5, 2026
CLIA Number13D2195033
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 6, 2024
Certificate Expiration DateOctober 5, 2026
Laboratory DirectorLynsie Sanchez
Laboratory Phone(208) 939-6499
Laboratory LocationEdgewood Spring Creek Eagle Island LLC77 N Fisher Park Way, Eagle, ID 83616
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 13D2205505

Edgewood Spring Creek Boise LLC · Boise, ID
Active · expires Dec 14, 2026
CLIA Number13D2205505
Laboratory TypeAssisted Living Facility
Certificate Effective DateDecember 15, 2024
Certificate Expiration DateDecember 14, 2026
Laboratory DirectorLisa Perrenound
Laboratory Phone(701) 738-2000
Laboratory LocationEdgewood Spring Creek Boise LLC10681 W Mcmillan Rd, Boise, ID 83713
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 13D2205510

Edgewood Spring Creek American Falls LLC · American Falls, ID
Active · expires Dec 14, 2026
CLIA Number13D2205510
Laboratory TypeAssisted Living Facility
Certificate Effective DateDecember 15, 2024
Certificate Expiration DateDecember 14, 2026
Laboratory DirectorLisa Perrenound
Laboratory Phone(701) 738-2000
Laboratory LocationEdgewood Spring Creek American Falls LLC605 Hillcrest Ave, American Falls, ID 83211
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Edgewood Spring Creek Eagle, LLC's NPI number?

The NPI number for Edgewood Spring Creek Eagle, LLC is 1003191149. It was assigned to this organization in the NPPES registry on October 20, 2011.

Where is Edgewood Spring Creek Eagle, LLC located?

Edgewood Spring Creek Eagle, LLC is located at 653 N Eagle Rd, Eagle, ID 83616. The listed phone number is (208) 938-5578.

What is Edgewood Spring Creek Eagle, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Edgewood Spring Creek Eagle, LLC hold CLIA laboratory certificates?

Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Edgewood Spring Creek Eagle, LLC was last updated on August 18, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.