Provider Demographics
NPI:1851415616
Name:BONNER SCHOOL DISTRICT 14
Entity Type:Organization
Organization Name:BONNER SCHOOL DISTRICT 14
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDIANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-258-6151
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:BONNER
Mailing Address - State:MT
Mailing Address - Zip Code:59823-1004
Mailing Address - Country:US
Mailing Address - Phone:406-258-6151
Mailing Address - Fax:406-258-6153
Practice Address - Street 1:9045 HWY 200
Practice Address - Street 2:
Practice Address - City:BONNER
Practice Address - State:MT
Practice Address - Zip Code:59823
Practice Address - Country:US
Practice Address - Phone:406-258-6151
Practice Address - Fax:406-258-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0164917Medicaid