Provider Demographics
NPI:1164281101
Name:BONTRAGER WELLNESS, INC.
Entity Type:Organization
Organization Name:BONTRAGER WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONTRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-525-4096
Mailing Address - Street 1:14784 PEACE RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7912
Mailing Address - Country:US
Mailing Address - Phone:317-525-4096
Mailing Address - Fax:
Practice Address - Street 1:601 HERITAGE DR STE 204
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2777
Practice Address - Country:US
Practice Address - Phone:317-525-4096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health