MEDICARE: BONNERS MEADOW HOME HEALTH AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		FL

General Provider Information

NPI Number	:	1891113601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BONNERS MEADOW HOME HEALTH AGENCY LLC

Provider Business Mailing Address
First Line	:	3541 EVANS AVE APT E210
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8363
Country	:	US
Telephone Number	:	239-785-7322
Fax Number	:

Provider Business Practice Location Address
First Line	:	3541 EVANS AVE APT E210
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8363
Country	:	US
Telephone Number	:	239-785-7322
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAMEON BONNER
Credential	:
Telephone Number	:	239-785-7322

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/31/2014

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