1447739339 NPI number — BOUNDLESS BEHAVIORAL HEALTH, 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 1447739339 NPI number — BOUNDLESS BEHAVIORAL HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOUNDLESS BEHAVIORAL HEALTH, 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:
BOUNDLESS
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:
1447739339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 LIBERTY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST CARROLLTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45449-2135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-724-2400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 LIBERTY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST CARROLLTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45449-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-247-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARNER
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
REIMBURSEMENT MANAGER
Authorized Official Telephone Number:
614-844-3800

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0302515 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".