Provider Demographics
NPI:1740264191
Name:BNHA HEALTH GROUP INC
Entity type:Organization
Organization Name:BNHA HEALTH GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NILESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTADIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-453-6553
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:STE 120
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2094
Mailing Address - Country:US
Mailing Address - Phone:310-453-6553
Mailing Address - Fax:310-828-5645
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:STE 120
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2094
Practice Address - Country:US
Practice Address - Phone:310-453-6553
Practice Address - Fax:310-828-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0003X
CAPHY435363336S0011X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY57666OtherPHARMACY BOP LICENSE
CAPHA435360Medicaid
0590895OtherOTHER ID NUMBER