EDGEWOOD PLANTATION PLACE LLC

NPI: 1023305497 · BOISE, ID 83703 · Assisted Living Facility · NPI assigned 07/06/2011

$201K

Total Medicaid Paid

105

Total Claims

Beneficiaries

Codes Billed

2024-03

First Month

2024-10

Last Month

Provider Details

Authorized Official	DYBWAD, JOHN (VP OF FINANCE)
NPI Enumeration Date	07/06/2011

Other providers sharing the same authorized official: DYBWAD, JOHN

Provider	City	State	Total Paid
EDGEWOOD FRUITLAND SENIOR LIVING LLC	FRUITLAND	ID	$2.55M
EDGEWOOD SPRING CREEK OVERLAND, LLC	BOISE	ID	$2.22M
EDGEWOOD CASTLE HILLS LLC	BOISE	ID	$2.06M
EDGEWOOD SPRING CREEK BOISE, LLC	BOISE	ID	$1.57M
EDGEWOOD SPRING CREEK EAGLE ISLAND LLC	BOISE	ID	$1.28M
EDGEWOOD SPRING CREEK AMERICAN FALLS, LLC	AMERICAN FALLS	ID	$1.03M
EDGEWOOD RAPID CITY LLC	RAPID CITY	SD	$639K
EDGEWOOD SPRING CREEK USTICK, LLC	MERIDIAN	ID	$502K
EDGEWOOD SPRING CREEK EAGLE, LLC	EAGLE	ID	$13K

Year	Claims	Total Paid
2024	105	$201K

Code	Description	Claims	Beneficiaries	Total Paid
S5140	Foster care, adult; per diem	105	87	$201K