Provider Demographics
NPI:1104542679
Name:BOHRDOM LLC
Entity type:Organization
Organization Name:BOHRDOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:CHARLES RAGER
Authorized Official - Last Name:BOHRER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:951-404-4380
Mailing Address - Street 1:23694 SARATOGA SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4806
Mailing Address - Country:US
Mailing Address - Phone:951-404-4380
Mailing Address - Fax:
Practice Address - Street 1:23694 SARATOGA SPRINGS PL
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4806
Practice Address - Country:US
Practice Address - Phone:951-404-4380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No174200000XOther Service ProvidersMeals