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General NPI Number Information
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NPI Number | 1417372475
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Entity Type | Organization
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Legal Business Name | BOLD SELAH, LLC
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 08/21/2016
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Provider Practice Location Address
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Address Line | 394 LATTINTOWN RD BASEMENT
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City | MARLBORO
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State | NY
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Zip | 12542-5507
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Country | US
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Telephone | 845-797-4177
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1
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City | BEACON
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State | NY
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Zip | 12508-0001
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Country | US
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Telephone | 845-797-4177
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DENISE BOLDS
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Credential | MSW
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Telephone | 845-797-4177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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