Provider Demographics
NPI:1538346408
Name:BONELL ELDERLY CARE
Entity type:Organization
Organization Name:BONELL ELDERLY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-565-0574
Mailing Address - Street 1:205 DAVID LARSEN DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:678-565-0574
Mailing Address - Fax:678-565-0574
Practice Address - Street 1:205 DAVID LARSEN DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:678-565-0574
Practice Address - Fax:678-565-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187342163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty