# BONAVENTURE PLACE RETIREMENT & ASSISTED LIVING COMMUNITY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bonaventure Retirement & Assisted Living Community
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063600062
- **Authorized official:** MR. KELLEY D HAMILTON (CEO AND PRESIDENT OF MANAGER)
- **Authorized official phone:** (503) 566-5715

## Contact information

- **Practice address:** 3220 STATE ST, SUITE 200, SALEM, OR 97301-6872
- **Practice address phone:** (503) 566-5715
- **Practice address fax:** (503) 588-3531
- **Mailing address:** 5850 N FIVE MILE RD, BOISE, ID 83713-5259
- **Mailing address phone:** (208) 429-6544
- **Mailing address fax:** (208) 429-6739

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | ID | Yes |

## Other

- **Enumeration date:** 10/04/2007
- **Last updated:** 10/04/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | W55531 | CERTIFICATE \# | ID |