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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up