Provider Demographics
NPI:1336285154
Name:BOSTA, GAIL GENTILE (PRIMARY SERVICE COOR)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:GENTILE
Last Name:BOSTA
Suffix:
Gender:F
Credentials:PRIMARY SERVICE COOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 WATER KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1402
Mailing Address - Country:US
Mailing Address - Phone:859-224-2187
Mailing Address - Fax:859-367-7202
Practice Address - Street 1:2621 WATER KNOLL CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1402
Practice Address - Country:US
Practice Address - Phone:859-224-2187
Practice Address - Fax:859-367-7202
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFS-1558171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator