Provider Demographics
NPI:1447870266
Name:HOUSE OF BOSTICS LLC (THE)
Entity type:Organization
Organization Name:HOUSE OF BOSTICS LLC (THE)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHALONDRIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOSTIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-550-7076
Mailing Address - Street 1:3586 53RD AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2412
Mailing Address - Country:US
Mailing Address - Phone:727-550-7076
Mailing Address - Fax:727-329-9031
Practice Address - Street 1:3586 53RD AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2412
Practice Address - Country:US
Practice Address - Phone:727-550-7076
Practice Address - Fax:727-329-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility