Provider Demographics
NPI:1639229834
Name:BOYS HOME ASSOCIATION
Entity Type:Organization
Organization Name:BOYS HOME ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAID SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-421-6040
Mailing Address - Street 1:2354 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3228
Mailing Address - Country:US
Mailing Address - Phone:904-421-6040
Mailing Address - Fax:904-744-8131
Practice Address - Street 1:2354 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3228
Practice Address - Country:US
Practice Address - Phone:904-421-6040
Practice Address - Fax:904-744-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health