Provider Demographics
NPI:1598705584
Name:BONNER GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:BONNER GENERAL HOSPITAL, INC.
Other - Org Name:BONNER GEN HOSP HOME HLTH SVC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-265-1100
Mailing Address - Street 1:PO BOX 1353
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0863
Mailing Address - Country:US
Mailing Address - Phone:208-265-1007
Mailing Address - Fax:208-265-1278
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
Practice Address - Country:US
Practice Address - Phone:208-263-1441
Practice Address - Fax:208-265-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDHH-110251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002274100Medicaid
ID137032Medicare Oscar/Certification