Provider Demographics
NPI:1972018877
Name:BOZARTH, JUNE IREE
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:IREE
Last Name:BOZARTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-1294
Mailing Address - Country:US
Mailing Address - Phone:269-753-1816
Mailing Address - Fax:
Practice Address - Street 1:614 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-1294
Practice Address - Country:US
Practice Address - Phone:269-753-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF130294904311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home