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General NPI Number Information
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NPI Number | 1316241912
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Entity Type | Organization
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Legal Business Name | BONNEY HOME INC
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Dates
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Enumeration Date | 12/22/2010
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 2021 BARBARA AVE
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City | GALLUP
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State | NM
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Zip | 87301-6705
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Country | US
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Telephone | 505-879-1587
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Fax | 505-863-6113
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Provider Business Mailing Address
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Address Line | 2021 BARBARA AVE
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City | GALLUP
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State | NM
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Zip | 87301-6705
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Country | US
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Telephone | 505-879-1587
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Fax | 505-863-6113
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MISS JULIANA OFOSUA BONNEY
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Credential |
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Telephone | 505-879-1587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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