Provider Demographics
NPI:1336671874
Name:BONNIE'S GUEST HOUSE INC.
Entity Type:Organization
Organization Name:BONNIE'S GUEST HOUSE INC.
Other - Org Name:BONNIES GUEST HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-400-1502
Mailing Address - Street 1:135 N BONNIE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2103
Mailing Address - Country:US
Mailing Address - Phone:213-400-1502
Mailing Address - Fax:
Practice Address - Street 1:135 N BONNIE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2103
Practice Address - Country:US
Practice Address - Phone:213-400-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1986010693104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA198601069OtherCOMMUNITY CARE LICENSING DIVISION