NPIMap

Organization Active NPI

Boundary Community Hospital

Doing business as Boundary County Nursing Home

  • Skilled Nursing Facility
  • Bonners Ferry, ID
National Provider Identifier
1225113152
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
H 43 Issued in ID
Legal business name
BOUNDARY COMMUNITY HOSPITAL
Doing business as
Boundary County Nursing Home
Practice address
6640 Kaniksu St
Bonners Ferry, ID 83805-7532
Phone
(208) 267-4850
Fax
(208) 267-2202
NPI assigned
Oct 26, 2006
Last updated
Jun 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Authorized official

Name
April D Bennett
Title
Ceo
Phone
(208) 267-4850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X H 43 ID Primary

Addresses

Primary practice location

6640 Kaniksu St
Bonners Ferry, ID 83805-7532

Mailing address

6640 Kaniksu St
Bonners Ferry, ID 83805-7532
Phone (208) 267-4850

Other identifiers 1

IdentifierTypeStateIssuer
1225113152MedicaidID

Other names 1

  • Boundary County Nursing Home Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050328001070 ID Part A Provider - Skilled Nursing Facility 3274583406 Practice locations: Bonners Ferry, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225113152. Details of each certification follow.

Skilled nursing facility certification: CCN 135004

Legal name
BOUNDARY COMMUNITY HOSPITAL
Doing business as
BOUNDARY COUNTY NURSING HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1967
Last certification
Sep 13, 2024
Beds
20
Ownership / control type
Individual
Organization structure
GovernmentNon-profit
Enrollment address
6640 Kaniksu St
Bonners Ferry, ID 83805-7532
Nursing home name
BOUNDARY COUNTY NURSING HOME

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Boundary County Nursing HomeCCN 135004 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Individual
Certified
Jan 1, 1967
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
2017.9 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Boundary Community Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Elden Koon Individual Trustee of the SNF Jan 1, 2001
Boundary Community Hospital Organization, Bonners Ferry, ID Non-profit Operational/Managerial Control Jan 1, 1966
Trustee of the SNF Jan 1, 1966
Adp of the SNF Dec 4, 2024
Paul Hazdovac Individual Trustee of the SNF Jan 1, 2010
April D Bennett Individual Corporate OfficerAdministrator / Ceo Jun 6, 2022 100%
Adp of the SNF Jun 6, 2022
Melinda B Smithson Individual Corporate OfficerCfo Feb 21, 2022
Adp of the SNF Feb 21, 2022
Tami M Corsi Individual Corporate DirectorDirector of Nursing Jul 30, 2015
Adp of the SNF Jul 30, 2015
Boundary County Organization, Bonners Ferry, ID 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Adp of the SNF Dec 4, 2024
Gregory T Botkin Individual Operational/Managerial Control Jan 1, 2001
Adp of the SNF Jan 1, 2001
Indirect Ownership Interest Jan 1, 2001

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Boundary Community HospitalBonners Ferry, ID, CCN 131301 Hospital Operational/Managerial Control Oct 4, 2007
Boundary Community HospitalBonners Ferry, ID, CCN 13Z301 Hospital Operational/Managerial Control Oct 4, 2007
Boundary Community HospitalBonners Ferry, ID, CCN 138521 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2014

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1225113152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6640 KANIKSU ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-4850",
            "fax_number": "208-267-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6640 KANIKSU ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-4850",
            "fax_number": "208-267-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNDARY COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "APRIL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-267-4850"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "H 43",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225113152",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boundary County Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boundary County Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bonners Ferry, ID

Sources for this page

Verify at the official NPI Registry.