Provider Demographics
NPI:1306200043
Name:BONITA HOMECARE, INC.
Entity Type:Organization
Organization Name:BONITA HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GASHAW
Authorized Official - Middle Name:HAILU
Authorized Official - Last Name:GEBRESELASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:SR ENGINEER
Authorized Official - Phone:619-746-6978
Mailing Address - Street 1:319 F ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2666
Mailing Address - Country:US
Mailing Address - Phone:619-746-6978
Mailing Address - Fax:619-779-7081
Practice Address - Street 1:319 F ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2666
Practice Address - Country:US
Practice Address - Phone:619-746-6978
Practice Address - Fax:619-779-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health