Bonaventure Place Retirement & Assisted Living Community LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

BONAVENTURE PLACE RETIREMENT & ASSISTED LIVING COMMUNITY LLC

Doing business as

Bonaventure Retirement & Assisted Living Community

Practice address

3220 State St
Suite 200
Salem, OR 97301-6872

Phone

(503) 566-5715

Fax

(503) 588-3531

NPI assigned

Oct 4, 2007

Last updated

Oct 4, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kelley D Hamilton

Title

Ceo and President of Manager

Phone

(503) 566-5715

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bonaventure Retirement & Assisted Living Community Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1063600062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5850 N FIVE MILE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837135259",
            "telephone_number": "208-429-6544",
            "fax_number": "208-429-6739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 STATE ST",
            "address_2": "SUITE 200",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973016872",
            "telephone_number": "503-566-5715",
            "fax_number": "503-588-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONAVENTURE PLACE RETIREMENT & ASSISTED LIVING COMMUNITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO AND PRESIDENT OF MANAGER",
        "authorized_official_telephone_number": "503-566-5715",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATE #",
            "identifier": "W55531",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bonaventure Retirement & Assisted Living Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Boltjes, LMT
• James Bonar, DMD
• Paul J Bonar, DMD
• Thomas Larance Bonar, DMD
• Victoria A Bonar, DMD
• Sarah Bond
• Searainya Bond, MFT
• Mary Evelyn Bonds, LCSW
• Alicia Bone Bone, LPC
• Beyounka Bonner

• Exclusive Provider Organization in Salem, OR
• Providers in Salem, OR by specialty
• Exclusive Provider Organization in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.