Bosley, Illene Rita

Bosley, Illene Rita is an individual health care provider with primary practice located at 13220 Woodward Ave , Highland Park MI 48203-3610. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Bosley, Illene Rita can be contacted via phone (313) 868-1946.

Contact Information

Primary practice address
13220 Woodward Ave Highland Park MI 48203-3610
Phone: (313) 868-1946
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 104259 Michigan

Profile Details

NPI number 1225156177
LBN Legal business name Bosley, Illene Rita
Credentials MS, CAC-I
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 27th, 2007
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225156177 NPPES
Michigan Other 1063545556 GENESIS HOUSE III
Michigan Other 1740313238 GENESIS HOUSE III
Michigan MEDICAID 3022440 GENESIS HOUSE III

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