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General NPI Number Information
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NPI Number | 1982112660
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Entity Type | Organization
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Legal Business Name | BONNER GENERAL HOSPITAL, INC
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 606 N 3RD AVE STE 203
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City | SANDPOINT
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State | ID
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Zip | 83864-1691
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Country | US
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Telephone | 208-265-1090
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1343
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City | SANDPOINT
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State | ID
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Zip | 83864-0863
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Country | US
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Telephone | 208-265-1158
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Fax | 208-265-1278
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Authorized Official
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Title or Position | CEO
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Name | JOHN HENNESSY
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Credential |
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Telephone | 208-265-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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