Provider Demographics
NPI: | 1629559349 |
---|---|
Name: | UNLIMITED BOUNDS HUMAN SERVICES LLC |
Entity Type: | Organization |
Organization Name: | UNLIMITED BOUNDS HUMAN SERVICES LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARKIS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 443-449-5135 |
Mailing Address - Street 1: | 1109 DULANEY GATE CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | COCKEYSVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21030-3012 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4200 PENNINGTON AVE |
Practice Address - Street 2: | |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21226-1324 |
Practice Address - Country: | US |
Practice Address - Phone: | 443-449-5135 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-08-22 |
Last Update Date: | 2023-01-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 247ZC0005X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Clinical Laboratory Director, Non-physician | Group - Multi-Specialty |