Provider Demographics
NPI:1891973392
Name:BONNEVILLE COUNTY
Entity Type:Organization
Organization Name:BONNEVILLE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY COMMISSIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-529-1360
Mailing Address - Street 1:605 N CAPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3582
Mailing Address - Country:US
Mailing Address - Phone:208-705-5071
Mailing Address - Fax:208-523-5974
Practice Address - Street 1:445 N CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3652
Practice Address - Country:US
Practice Address - Phone:208-705-5071
Practice Address - Fax:208-523-5974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-24942251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management