Provider Demographics
NPI:1891113601
Name:BONNERS MEADOW HOME HEALTH AGENCY LLC
Entity type:Organization
Organization Name:BONNERS MEADOW HOME HEALTH AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMEON
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-785-7322
Mailing Address - Street 1:3541 EVANS AVE APT E210
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8363
Mailing Address - Country:US
Mailing Address - Phone:239-785-7322
Mailing Address - Fax:
Practice Address - Street 1:3541 EVANS AVE APT E210
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8363
Practice Address - Country:US
Practice Address - Phone:239-785-7322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health