Healthcare Provider Details

I. General information

NPI: 1225113152
Provider Name (Legal Business Name): BOUNDARY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 KANIKSU ST
BONNERS FERRY ID
83805-7532
US

IV. Provider business mailing address

6640 KANIKSU ST
BONNERS FERRY ID
83805-7532
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-4850
  • Fax: 208-267-2202
Mailing address:
  • Phone: 208-267-4850
  • Fax: 208-267-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH 43
License Number StateID

VIII. Authorized Official

Name: APRIL D BENNETT
Title or Position: CEO
Credential:
Phone: 208-267-4850