1336565969 NPI number — BONAVENTURE HEALTH SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336565969 NPI number — BONAVENTURE HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BONAVENTURE HEALTH SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BONAVENTURE HEALTH SERVICES INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336565969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1175 NE 125TH ST STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33161-5831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-893-5364
Provider Business Mailing Address Fax Number:
877-669-7651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 NE 125TH ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33161-5831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-893-5364
Provider Business Practice Location Address Fax Number:
877-669-7651
Provider Enumeration Date:
03/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BELLANDE
Authorized Official First Name:
YVELINE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
ADMINISTRATION
Authorized Official Telephone Number:
305-893-5364

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  30211437 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SH0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com