Provider Demographics
NPI:1912158304
Name:BOSCHULTE'S PRIDE II LLC
Entity Type:Organization
Organization Name:BOSCHULTE'S PRIDE II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOSCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-751-6308
Mailing Address - Street 1:2242 S HAMILTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4300
Mailing Address - Country:US
Mailing Address - Phone:614-751-6308
Mailing Address - Fax:614-751-6342
Practice Address - Street 1:2242 S HAMILTON RD STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4300
Practice Address - Country:US
Practice Address - Phone:614-751-6308
Practice Address - Fax:614-751-6342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3073847Medicaid
OH3073847Medicaid