Healthcare Provider Details

I. General information

NPI: 1326423690
Provider Name (Legal Business Name): BOUNDLESS COMMUNITY PATHWAYS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LIBERTY LN
WEST CARROLLTON OH
45449-2135
US

IV. Provider business mailing address

445 E DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3192
US

V. Phone/Fax

Practice location:
  • Phone: 937-247-2400
  • Fax: 937-247-2424
Mailing address:
  • Phone: 614-844-3200
  • Fax: 614-515-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: MS. PATRICK MAYNARD
Title or Position: PRESIDENT AND CEO
Credential: PHD
Phone: 614-844-3800