Provider Demographics
| NPI: | 1598587974 |
|---|---|
| Name: | BONCHON HOME HEALTH CARE SERVICES LLC |
| Entity type: | Organization |
| Organization Name: | BONCHON HOME HEALTH CARE SERVICES LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SONITA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | NKANG |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 240-899-2471 |
| Mailing Address - Street 1: | 5969 E LIVINGSTON AVE STE 201C |
| Mailing Address - Street 2: | |
| Mailing Address - City: | COLUMBUS |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 43232-2907 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 667-324-7696 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 5969 E LIVINGSTON AVE STE 201C |
| Practice Address - Street 2: | |
| Practice Address - City: | COLUMBUS |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 43232-2907 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 667-324-7696 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-10-28 |
| Last Update Date: | 2024-10-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 251E00000X | Agencies | Home Health | ||
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant | Group - Single Specialty |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child | Group - Single Specialty |
