Provider Demographics
NPI:1326289356
Name:BONNY CREST HOME HEALTHCARE, INC
Entity Type:Organization
Organization Name:BONNY CREST HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHAKAKHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BA, BS
Authorized Official - Phone:918-949-4555
Mailing Address - Street 1:700 W FORT WORTH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3719
Mailing Address - Country:US
Mailing Address - Phone:918-949-4555
Mailing Address - Fax:918-933-5352
Practice Address - Street 1:700 W FORT WORTH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3719
Practice Address - Country:US
Practice Address - Phone:918-949-4555
Practice Address - Fax:918-933-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-21
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health