Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Edgewood Spring Creek Eagle Island LLC

Organization Assisted Living Facility · NPI 1114383577

Edgewood Spring Creek Eagle Island LLC is an Assisted Living Facility in Boise, Idaho. Licensed in Idaho. Registered with an NPI since 2016.

Licensed in
ID
In the registry since
2016
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12426 W Explorer Dr Ste 220
Boise, ID 83713-1560
Phone: (208) 947-4012
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Assisted Living Facility (primary) Taxonomy 310400000X · Licence RC1104 (ID)

Record details

NPI number1114383577
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Dybwad — Vp Of Finance · (701) 757-5422
NPI enumeratedJanuary 14, 2016
Last updated in NPPESAugust 19, 2022
Certification dateAugust 19, 2022
Mailing addressPo Box 13238, Grand Forks, ND 58208

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