Basic Information
| Provider Information | |||||||||
| NPI: | 1447739339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOUNDLESS HEALTH, INC. | ||||||||
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| OtherOrganizationName: | BOUNDLESS BEHAVIORAL HEALTH, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 E DUBLIN GRANVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WORTHINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430853192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148443800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 LIBERTY LN | ||||||||
| Address2: | |||||||||
| City: | WEST CARROLLTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454492135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372472400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2018 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GREENE | ||||||||
| AuthorizedOfficialFirstName: | RANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6148443800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0006X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 235Z00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 0302515 | 05 | OH | MEDICAID |