Provider Demographics
NPI:1669167490
Name:M. L. BOSE MEMORIAL HEALTH FOUNDATION, INC.
Entity type:Organization
Organization Name:M. L. BOSE MEMORIAL HEALTH FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:520-878-3600
Mailing Address - Street 1:327 DICKERSON DR N
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1703
Mailing Address - Country:US
Mailing Address - Phone:520-878-3600
Mailing Address - Fax:
Practice Address - Street 1:327 DICKERSON DR N
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1703
Practice Address - Country:US
Practice Address - Phone:520-878-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management