Organization
BONAVENTURE PLACE RETIREMENT & ASSISTED LIVING COMMUNITY LLC
Active
Other names
Bonaventure Retirement & Assisted Living Community
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLEY D HAMILTON (CEO AND PRESIDENT OF MANAGER)
(503) 566-5715
Entity
Organization
Contact information
Practice address
3220 STATE ST, SUITE 200, SALEM, OR 97301-6872
(503) 566-5715
(503) 588-3531
Mailing address
5850 N FIVE MILE RD, BOISE, ID 83713-5259
(208) 429-6544
(208) 429-6739
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W55531
CERTIFICATE #
ID
Enumeration date
10/04/2007
Last updated
10/04/2007
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