Provider Demographics
NPI:1508139189
Name:CECILIO EMANUEL CROSBY
Entity Type:Organization
Organization Name:CECILIO EMANUEL CROSBY
Other - Org Name:BONITA HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CECILIO
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
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:2012-02-13
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health