Active NPI
Michael Boese
- Assisted Living Facility
- Lodi, CA
National Provider Identifier
1619747276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 397005496
- Practice address
- 1330 W Walnut St
Lodi, CA 95242-3025 - Phone
- (916) 524-3521
- NPI assigned
- Jan 4, 2024
- Last updated
- Jan 4, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 397005496 | CA | Primary |
Addresses
Primary practice location
1330 W Walnut St
Lodi, CA 95242-3025
Mailing address
2750 E Collier Rd
Acampo, CA 95220-9201
Phone (916) 524-3521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 397005496 | CA | MD | Assisted Living Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704326400000",
"number": "1619747276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2750 E COLLIER RD",
"city": "ACAMPO",
"state": "CA",
"postal_code": "952209201",
"telephone_number": "916-524-3521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1330 W WALNUT ST",
"city": "LODI",
"state": "CA",
"postal_code": "952423025",
"telephone_number": "916-524-3521"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOESE",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-01-04",
"last_updated": "2024-01-04",
"certification_date": "2024-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "CA",
"license": "397005496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.