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EDGEWOOD SPRING CREEK EAGLE ISLAND, LLC

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Company Details

Name: EDGEWOOD SPRING CREEK EAGLE ISLAND, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 02 Mar 2015 (10 years ago)
Financial Date End: 31 Mar 2026
Entity Number: 451727
Place of Formation: IDAHO
File Number: 451727
ZIP code: 83713
County: Ada County
Principal Address: 12550 W EXPLORER DR SUITE 100 BOISE, ID 83713
Mailing Address: STE 200 402 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
Edgewood OpCo, LLC Member PO BOX 13238, GRAND FORKS, ND 58208 2022-04-22

Manager

Name Role Address Appointed On Resigned On
PHILIP GISI Manager 322 DEMERS AVENUE, STE 500, GRAND FORKS, ND 58201 2021-03-04 2022-04-22

National Provider Identifier

NPI Number:
1114383577
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 0006183795 2025-04-03
Annual Report 0006085435 2025-01-30
Annual Report 0005583840 2024-02-05
Annual Report 0005088036 2023-02-01
Annual Report 0004713487 2022-04-22

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Date of last update: 08 Apr 2025

Sources: Idaho Secretary of State