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EDGEWOOD SPRING CREEK OVERLAND, LLC
NPI 1497038301
Assisted Living Facility in Boise, ID

Active since September 27, 2011CLIA 13D2195029 · Waiver
10139 W OVERLAND RD, BOISE, ID 83709(208) 639-7000 Get Directions Write a Review

NPPES record last updated: August 19, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Edgewood Spring Creek Overland, Llc NPPES

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

EDGEWOOD SPRING CREEK OVERLAND, LLC (NPI 1497038301) is a healthcare organization registered as an assisted living facility in Boise, Idaho and active in the NPI registry since September 2011. The organization holds a CLIA Waiver certificate valid through October 5, 2026 and lists John Dybwad, Vp Of Finance, as its authorized official.

NPPES Registry Identity

NPI1497038301
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameEDGEWOOD SPRING CREEK OVERLAND, LLC
Location Address10139 W OVERLAND RDBoise, ID 83709-1429
Mailing AddressPo Box 13238Grand Forks, ND 58208 · (701) 738-2000
Phone(208) 639-7000
Organization SubpartNo
Authorized OfficialJohn DybwadVp Of Finance · (701) 757-5422
Enumeration DateSeptember 27, 2011
Last NPPES UpdateAugust 19, 2022
NPPES CertifiedAugust 19, 2022
✔ NPI 1497038301 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 · RC1009
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.

10139 W OVERLAND RD, Boise, ID 83709
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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 13D2195029

Edgewood Spring Creek Overland LLC · Boise, ID
Active · expires Oct 5, 2026
CLIA Number13D2195029
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 6, 2024
Certificate Expiration DateOctober 5, 2026
Laboratory DirectorRayvin Lough
Laboratory Phone(208) 639-7000
Laboratory LocationEdgewood Spring Creek Overland LLC10139 W Overland Rd, Boise, ID 83709
CLIA data matches this NPI record on: Address Name 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 Overland, LLC's NPI number?

The NPI number for Edgewood Spring Creek Overland, LLC is 1497038301. It was assigned to this organization in the NPPES registry on September 27, 2011.

Where is Edgewood Spring Creek Overland, LLC located?

Edgewood Spring Creek Overland, LLC is located at 10139 W Overland Rd, Boise, ID 83709. The listed phone number is (208) 639-7000.

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

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

Does Edgewood Spring Creek Overland, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2195029) is associated with this NPI, valid through October 5, 2026. 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 Spring Creek Overland, LLC was last updated on August 19, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.