Healthcare Provider Details

I. General information

NPI: 1033153739
Provider Name (Legal Business Name): CLEARWATER VALLEY HOSPITAL & CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CEDAR ST
OROFINO ID
83544-9029
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-476-4555
  • Fax: 208-476-5385
Mailing address:
  • Phone: 208-464-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateID

VIII. Authorized Official

Name: LENNE J BONNER
Title or Position: CEO
Credential:
Phone: 208-476-4555