| Elizabeth Boshoven Llc | |
|
4403 Cascade Road Se Suite 7 Grand Rapids MI 49546 | |
| (616) 309-4553 | |
| (616) 469-1078 |
| Full Name | Elizabeth Boshoven Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4403 Cascade Road Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Elizabeth Anne Boshoven (OWNER) |
| Authorized Official Contact | 6163094553 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elizabeth Boshoven Llc 4403 Cascade Road Se Suite 7 Grand Rapids MI 49546 Ph: (616) 309-4553 | Elizabeth Boshoven Llc 4403 Cascade Road Se Suite 7 Grand Rapids MI 49546 Ph: (616) 309-4553 |
| NPI Number | 1093126146 |
|---|---|
| Provider Enumeration Date | 05/12/2014 |
| Last Update Date | 04/01/2019 |
| Medicare PECOS PAC ID | 3072737055 |
|---|---|
| Medicare Enrollment ID | O20140612002110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093126146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801081555 (Michigan) | Primary |
| Provider Name | Elizabeth Anne Boshoven |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255401287 PECOS PAC ID: 5991706285 Enrollment ID: I20070130000274 |
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