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General NPI Number Information
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NPI Number | 1730968173
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Entity Type | Organization
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Legal Business Name | BOSS RECOVERY SERVICES
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 2600 W BROADWAY STE 318
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City | LOUISVILLE
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State | KY
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Zip | 40211-1366
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Country | US
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Telephone | 440-444-8302
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 W BROADWAY STE 318
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City | LOUISVILLE
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State | KY
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Zip | 40211-1366
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING AGENT
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Name | NASIRA MAH-JABEEN
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Credential |
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Telephone | 150-257-9017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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