Provider Demographics
NPI:1871850107
Name:BONNIE
Entity Type:Organization
Organization Name:BONNIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FISHER-LOVERDE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:585-969-2965
Mailing Address - Street 1:122 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14530-1217
Mailing Address - Country:US
Mailing Address - Phone:585-969-2966
Mailing Address - Fax:
Practice Address - Street 1:122 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:NY
Practice Address - Zip Code:14530-1217
Practice Address - Country:US
Practice Address - Phone:585-969-2966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142765-1261QA1903X, 311500000X, 311ZA0620X, 314000000X
NY142765315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient