Provider Demographics
NPI:1124384185
Name:BONNERS HOME CARE
Entity Type:Organization
Organization Name:BONNERS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PERRENOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-304-6854
Mailing Address - Street 1:65800 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-5231
Mailing Address - Country:US
Mailing Address - Phone:208-304-6854
Mailing Address - Fax:
Practice Address - Street 1:65800 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-5231
Practice Address - Country:US
Practice Address - Phone:208-304-6854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care