NPIMap

Organization Active NPI

I Am Boundless, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Mansfield, OH
National Provider Identifier
1861075707
Registry record updated Apr 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
I AM BOUNDLESS, INC
Practice address
592 Evelyn Ave
Mansfield, OH 44907-1787
Phone
(614) 844-3800
NPI assigned
Apr 29, 2021
Last updated
Apr 29, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
I AM BOUNDLESS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michelle Barner
Title
Reimbursement Manager
Phone
(614) 844-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

592 Evelyn Ave
Mansfield, OH 44907-1787

Mailing address

445 E Dublin Granville Rd
Worthington, OH 43085-3192
Phone (614) 844-3800

Other names 1

  • Evelyn Avenue Home Other name

National Provider Directory

National Provider Directory
Tax ID family
I Am Boundless Inc31 organizations share this tax ID, including this one
Part of
I Am Boundless Inc

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

Locations

592 Evelyn Ave
Mansfield, OH 44907
Phone (419) 522-0611

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619654400000",
    "number": "1861075707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 E DUBLIN GRANVILLE RD",
            "city": "WORTHINGTON",
            "state": "OH",
            "postal_code": "430853192",
            "telephone_number": "614-844-3800",
            "fax_number": "614-515-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "592 EVELYN AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449071787",
            "telephone_number": "614-844-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I AM BOUNDLESS, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "I AM BOUNDLESS, INC.",
        "enumeration_date": "2021-04-29",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "BARNER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "REIMBURSEMENT MANAGER",
        "authorized_official_telephone_number": "614-844-3800"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evelyn Avenue Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mansfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; 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.