Provider Demographics
NPI:1508759515
Name:THE BOULDIN FOUNDATION LLC
Entity type:Organization
Organization Name:THE BOULDIN FOUNDATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:NOAH
Authorized Official - Last Name:BOULDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:657-825-5321
Mailing Address - Street 1:13712 CHARLEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3207
Mailing Address - Country:US
Mailing Address - Phone:657-825-5321
Mailing Address - Fax:706-222-4741
Practice Address - Street 1:13712 CHARLEVILLE DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3207
Practice Address - Country:US
Practice Address - Phone:657-825-5321
Practice Address - Fax:706-222-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health