Healthcare Provider Details

I. General information

NPI: 1316241912
Provider Name (Legal Business Name): BONNEY HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 BARBARA AVE
GALLUP NM
87301-6705
US

IV. Provider business mailing address

2021 BARBARA AVE
GALLUP NM
87301-6705
US

V. Phone/Fax

Practice location:
  • Phone: 505-879-1587
  • Fax: 505-863-6113
Mailing address:
  • Phone: 505-879-1587
  • Fax: 505-863-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MISS JULIANA OFOSUA BONNEY
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 505-879-1587