Provider Demographics
NPI:1992414023
Name:BOSS 1 LLC
Entity type:Organization
Organization Name:BOSS 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMOINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-516-2823
Mailing Address - Street 1:3314 HENDERSON BLVD STE 100P
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2999
Mailing Address - Country:US
Mailing Address - Phone:813-516-2823
Mailing Address - Fax:813-569-6713
Practice Address - Street 1:3314 HENDERSON BLVD STE 100P
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2999
Practice Address - Country:US
Practice Address - Phone:813-516-2823
Practice Address - Fax:813-569-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services