NPI 1063600062

Bonaventure Place Retirement & Assisted Living Community LLC

Organisation Exclusive Provider Organization Salem, OR

Practice location

Address: 3220 State St Suite 200, Salem, OR 97301-6872
Phone: (503) 566-5715
Fax: (503) 588-3531
Mailing address: 5850 N Five Mile Rd, Boise, ID 83713-5259

Authorised official

Name: Kelley D Hamilton
Title: Ceo and President of Manager
Phone: (503) 566-5715

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in Oregon →

Registry record

NPI: 1063600062
Entity type: Organization
NPI issued: 4 Oct 2007
Record last updated: 4 Oct 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.