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General NPI Number Information
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NPI Number | 1124902846
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Entity Type | Organization
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Legal Business Name | I AM BOUNDLESS, INC
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 1125 GREEN TREE DR
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City | DAYTON
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State | OH
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Zip | 45429-6104
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Country | US
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Telephone | 614-844-3800
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Fax | 614-515-5779
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Provider Business Mailing Address
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Address Line | 445 E DUBLIN GRANVILLE RD STE H
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City | WORTHINGTON
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State | OH
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Zip | 43085-3192
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Country | US
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Telephone | 614-844-3800
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Fax | 614-844-3800
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Authorized Official
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Title or Position | CONTRACTING & CREDENTIALING MANAGER
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Name | LAURIE B HICKMAN
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Credential |
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Telephone | 614-844-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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