Provider Demographics
NPI:1619339181
Name:BOYHA LLC
Entity Type:Organization
Organization Name:BOYHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:404-667-0683
Mailing Address - Street 1:PO BOX 11334
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-0334
Mailing Address - Country:US
Mailing Address - Phone:404-667-0683
Mailing Address - Fax:
Practice Address - Street 1:110 RIVERSTONE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-5025
Practice Address - Country:US
Practice Address - Phone:404-667-0683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health