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EDGEWOOD FRUITLAND SENIOR LIVING LLC
NPI 1063840353
Assisted Living Facility in Fruitland, ID

Active since October 23, 2013CLIA 13D2067610 · Waiver
1255 ALLEN AVE, FRUITLAND, ID 83619(208) 452-5163 Get Directions Write a Review

NPPES record last updated: August 19, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Edgewood Fruitland Senior Living Llc NPPES

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

EDGEWOOD FRUITLAND SENIOR LIVING LLC (NPI 1063840353) is a healthcare organization registered as an assisted living facility in Fruitland, Idaho and active in the NPI registry since October 2013. The organization holds a CLIA Waiver certificate valid through October 20, 2027 and lists John Dybwad, Vp Of Finance, as its authorized official.

NPPES Registry Identity

NPI1063840353
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD FRUITLAND SENIOR LIVING LLC
Location Address1255 ALLEN AVEFruitland, ID 83619-2704
Mailing AddressPo Box 13238Grand Forks, ND 58208 · (701) 738-2000
Phone(208) 452-5163
Organization SubpartNo
Authorized OfficialJohn DybwadVp Of Finance · (701) 757-5422
Enumeration DateOctober 23, 2013
Last NPPES UpdateAugust 19, 2022
NPPES CertifiedAugust 19, 2022
✔ NPI 1063840353 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
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.

1255 ALLEN AVE, Fruitland, ID 83619
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CLIA Laboratory Certificates CMS CLIA

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 13D2067610

Edgewood Fruitland Senior Living LLC · Fruitland, ID
Active · expires Oct 20, 2027
CLIA Number13D2067610
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 21, 2025
Certificate Expiration DateOctober 20, 2027
Laboratory DirectorKarina Armenta
Laboratory Phone(541) 212-8727
Laboratory LocationEdgewood Fruitland Senior Living LLC1255 Allen Ave, Fruitland, ID 83619
CLIA data matches this NPI record on: Address Name
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 Fruitland Senior Living LLC's NPI number?

The NPI number for Edgewood Fruitland Senior Living LLC is 1063840353. It was assigned to this organization in the NPPES registry on October 23, 2013.

Where is Edgewood Fruitland Senior Living LLC located?

Edgewood Fruitland Senior Living LLC is located at 1255 Allen Ave, Fruitland, ID 83619. The listed phone number is (208) 452-5163.

What is Edgewood Fruitland Senior Living LLC's specialty?

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

Does Edgewood Fruitland Senior Living LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2067610) is associated with this NPI, valid through October 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Edgewood Fruitland Senior Living LLC was last updated on August 19, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.