Provider Demographics
NPI:1730719907
Name:BOLDEN, ANGELA FAY
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:FAY
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 OLD BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-8039
Mailing Address - Country:US
Mailing Address - Phone:846-226-6507
Mailing Address - Fax:
Practice Address - Street 1:574 OLD BAILEY RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8039
Practice Address - Country:US
Practice Address - Phone:846-226-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health