Provider Demographics
NPI:1316241912
Name:BONNEY HOME INC
Entity type:Organization
Organization Name:BONNEY HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:OFOSUA
Authorized Official - Last Name:BONNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-879-1587
Mailing Address - Street 1:2021 BARBARA AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6705
Mailing Address - Country:US
Mailing Address - Phone:505-879-1587
Mailing Address - Fax:505-863-6113
Practice Address - Street 1:2021 BARBARA AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6705
Practice Address - Country:US
Practice Address - Phone:505-879-1587
Practice Address - Fax:505-863-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD2823Medicaid