Provider Demographics
NPI:1710645106
Name:DEBOSEENTERPRISE
Entity Type:Organization
Organization Name:DEBOSEENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLESHIA
Authorized Official - Middle Name:SHERRAY
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-376-1761
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57101-0158
Mailing Address - Country:US
Mailing Address - Phone:605-376-1761
Mailing Address - Fax:
Practice Address - Street 1:3317 E 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-3457
Practice Address - Country:US
Practice Address - Phone:605-376-1761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health