MEDICARE: B.O.S.S. INTEGRATED HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1811595077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B.O.S.S. INTEGRATED HEALTHCARE

Provider Business Mailing Address
First Line	:	4150 W PEORIA AVE STE 216
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3955
Country	:	US
Telephone Number	:	480-370-1863
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 W PEORIA AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3900
Country	:	US
Telephone Number	:	480-343-8901
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALAN BOSS
Credential	:
Telephone Number	:	480-370-1863

Provider Enumeration Date	:	10/11/2020
Last Update Date	:	12/17/2020

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Directions to “B.O.S.S. INTEGRATED HEALTHCARE ” Practice Location

Language	Start Address	Practice Location

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