Boone Guest Home

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

050615 Issued in CO

Legal business name

BOONE GUEST HOME

Practice address

1339 S Pueblo Blvd
Pueblo, CO 81005-1686

Phone

(719) 564-0163

Fax

(719) 564-0193

NPI assigned

Apr 18, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jonna K McClure

Title

Owner/Director

Phone

(719) 564-0163

Specialties & licenses 3

Addresses

Other identifiers 2

Tax ID family

Boone Guest Home2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Boone Guest Home

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Boone, CO
  • NPI 1518407808
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447891200000",
    "number": "1396035887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1339 S PUEBLO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051686",
            "telephone_number": "719-564-0163",
            "fax_number": "719-564-0193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1339 S PUEBLO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810051686",
            "telephone_number": "719-564-0163",
            "fax_number": "719-564-0193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOONE GUEST HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-18",
        "last_updated": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "MCCLURE",
        "authorized_official_first_name": "JONNA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "719-564-0163"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CO",
            "license": "050615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "84622814",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52880711",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenyetta Bond
• Derek J Bonds, LCPC
• Kyle Andrew Bonds, PHARM.D.
• Amber Bonjour
• Charles Stephen Bonney, MD
• Kaitlin Booth, CRNA
• Martina Louise Borden, R.N.
• Paula Borden, R.M.T, L.L.C.C
• Sheryce Borgatti
• Jenna E Borgstrom

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.