Provider Demographics
NPI:1003922295
Name:BONFEE INC
Entity Type:Organization
Organization Name:BONFEE INC
Other - Org Name:BONFEE MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ACHIKE
Authorized Official - Last Name:AGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-515-6151
Mailing Address - Street 1:550 E CARSON PLAZA DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3229
Mailing Address - Country:US
Mailing Address - Phone:310-515-6151
Mailing Address - Fax:310-515-6261
Practice Address - Street 1:550 E CARSON PLAZA DR
Practice Address - Street 2:SUITE 113
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3229
Practice Address - Country:US
Practice Address - Phone:310-515-6151
Practice Address - Fax:310-515-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44628332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100641115OtherBOARD OF EQUALIZATION
CA5544720001Medicare NSC