Provider Demographics
NPI:1922676378
Name:BONA VITA HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:BONA VITA HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HASMIK
Authorized Official - Middle Name:JASMINE
Authorized Official - Last Name:ATSHEMYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-672-4848
Mailing Address - Street 1:17613 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17613 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3907
Practice Address - Country:US
Practice Address - Phone:323-672-4848
Practice Address - Fax:818-351-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care