Healthcare Provider Details

I. General information

NPI: 1669167490
Provider Name (Legal Business Name): M. L. BOSE MEMORIAL HEALTH FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 DICKERSON DR N
CAMILLUS NY
13031-1703
US

IV. Provider business mailing address

327 DICKERSON DR N
CAMILLUS NY
13031-1703
US

V. Phone/Fax

Practice location:
  • Phone: 520-878-3600
  • Fax:
Mailing address:
  • Phone: 520-878-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ASHOKE BOSE
Title or Position: FOUNDER/CEO
Credential: MHA
Phone: 520-878-3600