Provider Demographics
NPI:1912020686
Name:BONNIE CARE MEDICAL RESOURCES, LLC.
Entity Type:Organization
Organization Name:BONNIE CARE MEDICAL RESOURCES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:773-353-5061
Mailing Address - Street 1:3413 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4040
Mailing Address - Country:US
Mailing Address - Phone:773-353-5061
Mailing Address - Fax:773-249-4012
Practice Address - Street 1:3413 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4040
Practice Address - Country:US
Practice Address - Phone:773-353-5061
Practice Address - Fax:773-249-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000907332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5893860001Medicare NSC