Provider Demographics
NPI:1356590616
Name:BONES ON WHEELS
Entity type:Organization
Organization Name:BONES ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:X-RAY
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-535-9665
Mailing Address - Street 1:3432 STONEHALL DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3432 STONEHALL DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1028
Practice Address - Country:US
Practice Address - Phone:240-535-9665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances