Healthcare Provider Details

I. General information

NPI: 1154186039
Provider Name (Legal Business Name): BOUNDARY REGIONAL COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6612 COMANCHE ST
BONNERS FERRY ID
83805-7523
US

IV. Provider business mailing address

PO BOX 2160
SANDPOINT ID
83864-0908
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-7101
  • Fax:
Mailing address:
  • Phone: 208-263-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEVIN KNEPPER
Title or Position: CEO
Credential:
Phone: 208-263-3410