Provider Demographics
NPI:1265155691
Name:EMBRACE BEHAVIORAL HEALTH, PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:EMBRACE BEHAVIORAL HEALTH, PROFESSIONAL NURSING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAZMYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:949-668-3635
Mailing Address - Street 1:380 S MELROSE DR # 123
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6641
Mailing Address - Country:US
Mailing Address - Phone:949-668-3635
Mailing Address - Fax:949-288-0251
Practice Address - Street 1:380 S MELROSE DR STE 123
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6641
Practice Address - Country:US
Practice Address - Phone:949-668-3635
Practice Address - Fax:949-288-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty