Provider Demographics
NPI:1073900049
Name:BOLD HEALTHCARE INNOVATIONS MANAGEMENT
Entity Type:Organization
Organization Name:BOLD HEALTHCARE INNOVATIONS MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-250-0315
Mailing Address - Street 1:6505 MELWOOD ST APT 2323
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-1791
Mailing Address - Country:US
Mailing Address - Phone:214-250-0315
Mailing Address - Fax:
Practice Address - Street 1:6505 MELWOOD ST APT 2323
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-1791
Practice Address - Country:US
Practice Address - Phone:214-250-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care