Provider Demographics
NPI:1841676459
Name:BOLAT INCORPORATED
Entity type:Organization
Organization Name:BOLAT INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FEMI
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:ABATAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-706-2860
Mailing Address - Street 1:1150 4TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1607
Mailing Address - Country:US
Mailing Address - Phone:651-706-2860
Mailing Address - Fax:651-319-0940
Practice Address - Street 1:1150 4TH STREET WEST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1607
Practice Address - Country:US
Practice Address - Phone:651-706-2860
Practice Address - Fax:651-319-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities