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EDGEWOOD SPRING CREEK BOISE LLC

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Company Details

Name: EDGEWOOD SPRING CREEK BOISE LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 08 Aug 2011 (14 years ago)
Financial Date End: 31 Aug 2025
Entity Number: 326051
Place of Formation: IDAHO
File Number: 326051
Principal Address: PO BOX 13238 GRAND FORKS, ND 58208
Mailing Address: PO BOX 13238 GRAND FORKS, ND 58208-3238

Agent

Name Role Address
CORPORATION SERVICE COMPANY Agent 1305 12TH AVE RD, NAMPA, ID 83686

Member

Name Role Address Appointed On Resigned On
Edgewood OpCo LLC Member 322 DEMERS AVE STE 300, GRAND FORKS, ND 58201 2022-11-09 No data
Edgewood OpCo, LLC Member PO BOX 13238, GRAND FORKS, ND 58208 2021-09-02 2022-11-09

Manager

Name Role Address Appointed On Resigned On
Philip Gisi Manager 322 DEMERS AVE, GRAND FORKS, ND 58201 2020-08-10 2021-09-02

National Provider Identifier

NPI Number:
1871876789
Certification Date:
2022-08-19

Authorized Person:

Name:
JOHN DYBWAD
Role:
VP OF FINANCE
Phone:

Taxonomy:

Selected Taxonomy:
310400000X - Assisted Living Facility
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005812725 2024-07-08
Annual Report 0005300017 2023-07-03
Application for Reinstatement 0004988519 2022-11-09
Dissolution/Revocation - Administrative 0004977369 2022-11-05
Registered Agent Name/Address Change (mass change) 0004639429 2022-03-08

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Date of last update: 08 May 2025

Sources: Idaho Secretary of State