MEDICARE: BOUNDLESS HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1831696442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUNDLESS HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	7174 US HIGHWAY 64 STE 123
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-8954
Country	:	US
Telephone Number	:
Fax Number	:	901-504-6731

Provider Business Practice Location Address
First Line	:	7174 US HIGHWAY 64 STE 123
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-8954
Country	:	US
Telephone Number	:	901-214-5276
Fax Number	:	901-504-6731

Authorized Official
Title or Position	:	COO
Name	:	SHEENA HAYES
Credential	:
Telephone Number	:	901-214-5276

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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Directions to “BOUNDLESS HEALTHCARE LLC ” Practice Location

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