Provider Demographics
NPI:1194838839
Name:BOLEY CENTERS, INC.
Entity Type:Organization
Organization Name:BOLEY CENTERS, INC.
Other - Org Name:BOLEY CENTERS FOR BEHAVIORAL HEALTH CARE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACMATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-821-4819
Mailing Address - Street 1:445 31ST STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7605
Mailing Address - Country:US
Mailing Address - Phone:727-821-4819
Mailing Address - Fax:727-822-6240
Practice Address - Street 1:647 34TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3730
Practice Address - Country:US
Practice Address - Phone:727-821-4819
Practice Address - Fax:727-822-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72310Medicare ID - Type UnspecifiedMEDICAL OFFICE