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EDGEWOOD FRUITLAND SENIOR LIVING, LLC

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Company Details

Name: EDGEWOOD FRUITLAND SENIOR LIVING, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 06 May 2013 (12 years ago)
Financial Date End: 31 May 2026
Entity Number: 383136
Place of Formation: IDAHO
File Number: 383136
Principal Address: 322 DEMERS AVENUE STE 500 PO BOX 13238 GRAND FORKS, ND 58201
Mailing Address: STE 300 322 DEMERS AVE GRAND FORKS, ND 58201-4754

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 13238 PO BOX, GRAND FORKS, ND 58208-3238 2022-06-20 No data
Philip Gisi Member 13238 PO BOX, GRAND FORKS, ND 58208-3238 2021-05-18 2022-06-20

National Provider Identifier

NPI Number:
1063840353
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 0006179286 2025-04-01
Annual Report 0005684073 2024-04-08
Annual Report 0005183271 2023-04-05
Annual Report 0004787185 2022-06-20
Registered Agent Name/Address Change (mass change) 0004639720 2022-03-08

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Date of last update: 04 Jun 2025

Sources: Idaho Secretary of State