Healthcare Provider Details

I. General information

NPI: 1275643355
Provider Name (Legal Business Name): BOST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 S ZERO ST
FORT SMITH AR
72903-6644
US

IV. Provider business mailing address

PO BOX 11495
FORT SMITH AR
72917-1495
US

V. Phone/Fax

Practice location:
  • Phone: 479-784-1462
  • Fax: 479-784-1471
Mailing address:
  • Phone: 479-478-5609
  • Fax: 501-897-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA1204035
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1275643355
License Number StateAR

VIII. Authorized Official

Name: FRANCIS LYNNE STOUT
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 479-478-5609