Provider Demographics
NPI:1093545519
Name:CHEZ BON GUEST HOME
Entity type:Organization
Organization Name:CHEZ BON GUEST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-668-1070
Mailing Address - Street 1:1206 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3823
Mailing Address - Country:US
Mailing Address - Phone:562-668-1070
Mailing Address - Fax:
Practice Address - Street 1:1206 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3823
Practice Address - Country:US
Practice Address - Phone:562-668-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home