Boulderwood Estates LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

BOULDERWOOD ESTATES LLC

Practice address

1111 Care Ave
Nixa, MO 65714-9679

Phone

(417) 374-7755

NPI assigned

Aug 28, 2016

Organization subpart

No

Name

Kevin Edmonds

Title

Member

Phone

(417) 860-1300

• boulderwood estates Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 28, 2016.

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472342400000",
    "number": "1669928834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 870",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657140870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 CARE AVE",
            "city": "NIXA",
            "state": "MO",
            "postal_code": "657149679",
            "telephone_number": "417-374-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDERWOOD ESTATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2016-08-28",
        "status": "A",
        "authorized_official_last_name": "EDMONDS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "417-860-1300"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "boulderwood estates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aaron Blevins, PHARMD., R.PH.
• Blue Medical LLC
• Steven J Boling, PSYD, LPC
• Daniel Austin Boone, OD
• Daniel E Boone, O.D.
• Angela J. Boyer-Krause, MS, LPC
• Suzanne N Bradshaw, MA, LPC
• Renee Lynn Brake
• Richard Brantner
• Melissa June Brauer

• All providers in Nixa, MO
• In Home Supportive Care Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.