Provider Demographics
NPI:1033640008
Name:CHEZ BON HOME, INC.
Entity Type:Organization
Organization Name:CHEZ BON HOME, INC.
Other - Org Name:CHEZ BON GUEST HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICER OF THE CORPORATION
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-453-9882
Mailing Address - Street 1:1206 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3823
Mailing Address - Country:US
Mailing Address - Phone:562-591-1411
Mailing Address - Fax:562-591-0455
Practice Address - Street 1:1206 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3823
Practice Address - Country:US
Practice Address - Phone:562-591-1411
Practice Address - Fax:562-591-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197800441311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home