Provider Demographics
NPI:1568857589
Name:BONITA SPRINGS HOME HEALTH LLC
Entity Type:Organization
Organization Name:BONITA SPRINGS HOME HEALTH LLC
Other - Org Name:BONITA SPRINGS HOME HEALTH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYEDA
Authorized Official - Middle Name:MAMOONA
Authorized Official - Last Name:OMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-337-8117
Mailing Address - Street 1:8545 MONTEREY ST
Mailing Address - Street 2:SUITE-A
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4273
Mailing Address - Country:US
Mailing Address - Phone:408-337-8117
Mailing Address - Fax:408-337-8220
Practice Address - Street 1:8545 MONTEREY ST
Practice Address - Street 2:SUITE-A
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4273
Practice Address - Country:US
Practice Address - Phone:408-337-8117
Practice Address - Fax:408-337-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health