Provider Demographics
NPI:1598195869
Name:BONNI S. BISHOP, LLC
Entity Type:Organization
Organization Name:BONNI S. BISHOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNI
Authorized Official - Middle Name:S
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-361-2709
Mailing Address - Street 1:2406 S.R. 60 EAST #423
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594
Mailing Address - Country:US
Mailing Address - Phone:813-361-2709
Mailing Address - Fax:
Practice Address - Street 1:2406 STATE ROAD 60 EAST
Practice Address - Street 2:#423
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594
Practice Address - Country:US
Practice Address - Phone:813-361-2709
Practice Address - Fax:813-685-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7847314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility