Provider Demographics
NPI:1770246845
Name:BOSHALI LLC
Entity Type:Organization
Organization Name:BOSHALI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:IDRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMEDZAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-215-3761
Mailing Address - Street 1:2853 W WALNUT HILL LN APT 2089
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-5238
Mailing Address - Country:US
Mailing Address - Phone:903-215-3761
Mailing Address - Fax:
Practice Address - Street 1:2853 W WALNUT HILL LN APT 2089
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-5238
Practice Address - Country:US
Practice Address - Phone:903-215-3761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)