Provider Demographics
NPI:1487415014
Name:BOSWORTH GARDEN LLC
Entity type:Organization
Organization Name:BOSWORTH GARDEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-713-4215
Mailing Address - Street 1:1340 BOSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-2337
Mailing Address - Country:US
Mailing Address - Phone:619-588-5843
Mailing Address - Fax:619-588-5843
Practice Address - Street 1:1340 BOSWORTH ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2337
Practice Address - Country:US
Practice Address - Phone:619-588-5843
Practice Address - Fax:619-588-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility