Provider Demographics
NPI:1245936293
Name:BOSTON MEDICAL CARE LLC
Entity type:Organization
Organization Name:BOSTON MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED
Authorized Official - Phone:239-206-1200
Mailing Address - Street 1:3903 DR MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-4805
Mailing Address - Country:US
Mailing Address - Phone:239-851-7500
Mailing Address - Fax:
Practice Address - Street 1:3903 DR MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-4805
Practice Address - Country:US
Practice Address - Phone:239-851-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of Service
No251300000XAgenciesLocal Education Agency (LEA)Group - Single Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1679209142Medicaid