Provider Demographics
NPI:1083014864
Name:BONITA SPRINGS HOSPICE CARE LLC
Entity Type:Organization
Organization Name:BONITA SPRINGS HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYEDA
Authorized Official - Middle Name:MAMOONA
Authorized Official - Last Name:OMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-848-1114
Mailing Address - Street 1:8545 MONTEREY ST
Mailing Address - Street 2:UNIT-B
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4273
Mailing Address - Country:US
Mailing Address - Phone:408-848-1114
Mailing Address - Fax:408-848-1115
Practice Address - Street 1:8545 MONTEREY ST
Practice Address - Street 2:UNIT B
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4273
Practice Address - Country:US
Practice Address - Phone:408-848-1114
Practice Address - Fax:408-848-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based