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General NPI Number Information
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NPI Number | 1386627818
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Entity Type | Organization
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Legal Business Name | BOLTON HEALTHCARE, LLC
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 1300 S FRAZIER ST SUITE 205
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City | CONROE
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State | TX
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Zip | 77301-4400
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Country | US
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Telephone | 936-828-3739
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Fax | 936-828-3741
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Provider Business Mailing Address
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Address Line | PO BOX 841
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City | ELKHART
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State | TX
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Zip | 75839-0841
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Country | US
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Telephone | 904-764-0033
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Fax | 903-764-1556
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROY H. BOLTON
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Credential | RN
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Telephone | 903-764-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 1810244-03
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 012073
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License Number State | TX
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