Provider Demographics
NPI:1972343127
Name:BONITA GUEST HOME LLC
Entity type:Organization
Organization Name:BONITA GUEST HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CAROLINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-472-8884
Mailing Address - Street 1:5735 SUNNY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5735 SUNNY VIEW DR
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-2952
Practice Address - Country:US
Practice Address - Phone:619-472-8884
Practice Address - Fax:619-472-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-27
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility