Bonita Health Clinic

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BONITA HEALTH CLINIC

Practice address

6124 Landover Rd
Cheverly, MD 20785-1016

Phone

(215) 500-7580

NPI assigned

Oct 9, 2019

Last updated

Oct 9, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

RAJAEE BLACK LLCAs reported in NPPES

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

Authorized official

Name

Mr. Rajaee Black, CRNA

Title

President

Phone

(215) 500-7580

Specialties & licenses 5

Addresses

Part of

Bonita Health Clinic

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

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1740822915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 PINEY BRANCH CIR APT 509",
            "city": "HANOVER",
            "state": "MD",
            "postal_code": "210761838",
            "telephone_number": "215-500-7580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6124 LANDOVER RD",
            "city": "CHEVERLY",
            "state": "MD",
            "postal_code": "207851016",
            "telephone_number": "215-500-7580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONITA HEALTH CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RAJAEE BLACK LLC",
        "enumeration_date": "2019-10-09",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "RAJAEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-500-7580",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Cheverly, MD
• Providers in Cheverly, MD by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; 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.