Provider Demographics
NPI:1912791872
Name:BOULEVARD OPERATOR LLC
Entity type:Organization
Organization Name:BOULEVARD OPERATOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE ADMINISTRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MINDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:POSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-825-2217
Mailing Address - Street 1:9229 ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2504
Mailing Address - Country:US
Mailing Address - Phone:703-385-0555
Mailing Address - Fax:
Practice Address - Street 1:9229 ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2504
Practice Address - Country:US
Practice Address - Phone:703-385-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility