Healthcare Provider Details

I. General information

NPI: 1871695288
Provider Name (Legal Business Name): BONUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S 2ND ST
GRAYVILLE IL
62844-1527
US

IV. Provider business mailing address

320 SOUTH SECOND STREET
GRAYVILLE IL
62844-1567
US

V. Phone/Fax

Practice location:
  • Phone: 618-375-2171
  • Fax: 618-375-7756
Mailing address:
  • Phone: 618-375-2171
  • Fax: 618-375-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0019356
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0019356
License Number StateIL

VIII. Authorized Official

Name: MR. MICHAEL ANDREW CUNNINGHAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 618-375-2171