Provider Demographics
NPI:1801053277
Name:BONAVENTE CORPORATION
Entity type:Organization
Organization Name:BONAVENTE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BONAVENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-313-9052
Mailing Address - Street 1:6429 N ELLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2410
Mailing Address - Country:US
Mailing Address - Phone:559-271-9803
Mailing Address - Fax:559-275-8438
Practice Address - Street 1:6429 N ELLENDALE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2410
Practice Address - Country:US
Practice Address - Phone:559-271-9803
Practice Address - Fax:559-275-8438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities