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Organization
BATS BILLING
Active
Organization
BATS BILLING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRUCE BOSTOM (DIRECTOR)
(561) 795-0018
Entity
Organization
Contact information
Practice address
4926 SW 32ND WAY, FORT LAUDERDALE, FL 33312-7942
(561) 795-0018
(561) 792-4142
Mailing address
4926 SW 32ND WAY, FORT LAUDERDALE, FL 33312-7942
(561) 795-0018
(561) 792-4142
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L14000138552
LICENSE
FL
Enumeration date
11/17/2014
Last updated
11/17/2014
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