Provider Demographics
NPI:1073562591
Name:BONNER GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:BONNER GENERAL HOSPITAL, INC.
Other - Org Name:BONNER COMMUNITY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER BONNER GENE
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-263-1441
Mailing Address - Street 1:520 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1507
Mailing Address - Country:US
Mailing Address - Phone:208-265-1179
Mailing Address - Fax:208-265-1085
Practice Address - Street 1:520 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1507
Practice Address - Country:US
Practice Address - Phone:208-265-1179
Practice Address - Fax:208-265-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002274200Medicaid
WA3990967Medicaid
WA3990967Medicaid