Healthcare Provider Details

I. General information

NPI: 1336671874
Provider Name (Legal Business Name): BONNIE'S GUEST HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N BONNIE AVE
PASADENA CA
91106-2103
US

IV. Provider business mailing address

135 N BONNIE AVE
PASADENA CA
91106-2103
US

V. Phone/Fax

Practice location:
  • Phone: 213-400-1502
  • Fax:
Mailing address:
  • Phone: 213-400-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number198601069
License Number StateCA

VIII. Authorized Official

Name: MRS. DESIREE ALVARADO
Title or Position: CERTIFIED ADMINISTRATOR
Credential:
Phone: 213-400-1502