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General NPI Number Information
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NPI Number | 1053962498
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Entity Type | Individual
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Provider Name | CHERRY BOLDEN C.E.O
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Gender | Female
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 1126 HILLTOP DR
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City | LAWRENCE
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State | KS
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Zip | 66044-4530
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Country | US
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Telephone | 785-424-7470
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 WILDWOOD DR
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City | LAWRENCE
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State | KS
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Zip | 66049-3752
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Country | US
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Telephone | 785-979-8660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | B023022
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License Number State | KS
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