Healthcare Provider Details

I. General information

NPI: 1457030272
Provider Name (Legal Business Name): BOSTIC HEALTH HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/18/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 BUFFALO CREEK RD
LAKE LURE NC
28746
US

IV. Provider business mailing address

PO BOX 2568
HICKORY NC
28603-2568
US

V. Phone/Fax

Practice location:
  • Phone: 828-436-5370
  • Fax:
Mailing address:
  • Phone: 828-270-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES E TREFZGER JR.
Title or Position: MANAGER
Credential:
Phone: 828-322-5535