Provider Demographics
NPI:1073784674
Name:FLORENCE BOUA LLC
Entity Type:Organization
Organization Name:FLORENCE BOUA LLC
Other - Org Name:HOME BUDDIES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1800-332-6153
Mailing Address - Street 1:11006 VEIRS MILL RD STE L15
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5923
Mailing Address - Country:US
Mailing Address - Phone:240-638-0811
Mailing Address - Fax:800-332-6153
Practice Address - Street 1:6309 HOLLAND MEADOW LN
Practice Address - Street 2:
Practice Address - City:LAYTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20882-1235
Practice Address - Country:US
Practice Address - Phone:240-638-0811
Practice Address - Fax:800-332-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health