Edgewood Fruitland Senior Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDGEWOOD FRUITLAND SENIOR LIVING LLC

Practice address

1255 Allen Ave
Fruitland, ID 83619-2704

Phone

(208) 452-5163

NPI assigned

Oct 23, 2013

Last updated

Aug 19, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Dybwad

Title

VP of Finance

Phone

(701) 757-5422

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660867200000",
    "number": "1063840353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13238",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "58208",
            "telephone_number": "701-738-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 ALLEN AVE",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192704",
            "telephone_number": "208-452-5163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEWOOD FRUITLAND SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-23",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "DYBWAD",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "701-757-5422"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Allen Duncan, DC
• Ellen Dutcher, FNP
• Luann Dunn Dyer, LCPC
• Jacob Allen Dyreng, HIS
• Andrew Echanis, LMSW
• Lindsey Edmunds, O.D.
• Isaac L Elam, MD
• Elevate Ventures, LLC (Happier at Home)
• Page Lyn Erntson, LCSW
• Evergreen Prosthetics and Orthotics, LLC

• Assisted Living Facility in Fruitland, ID
• Providers in Fruitland, ID by specialty
• Assisted Living Facility in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.