Provider Demographics
NPI:1114578143
Name:BOLTON AND BOLTON COMMUNITY SERVICES
Entity Type:Organization
Organization Name:BOLTON AND BOLTON COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KORTNEY
Authorized Official - Middle Name:LAKILY
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-879-3043
Mailing Address - Street 1:1631 CALLAWAY LOOP
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3672
Mailing Address - Country:US
Mailing Address - Phone:678-879-3043
Mailing Address - Fax:
Practice Address - Street 1:1631 CALLAWAY LOOP
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3672
Practice Address - Country:US
Practice Address - Phone:678-879-3043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care