Zachary Edward Boller | South Bend, IN • PECOS Search

Zachary Edward Boller

Behavior Technician

Behavioral Health & Social Service Providers

17390 Dugdale Dr Ste 100, South Bend, IN 46635-1512

(574) 400-2169 (855) 324-0885

PECOS Enrollment

Based on the most recent information from CMS, provider Zachary Edward Boller does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:33 PM.

Profile Details

Provider ID
1669085908
Provider Type
Individual
Full Name
Boller, Zachary Edward
Credential
BS

Gender
Male
Sole Proprietor
No
Enumeration Date
8/26/2020
Last Updated
8/26/2020

Contact Information

Practice Location

17390 Dugdale Dr Ste 100, South Bend, IN 46635-1512

(317) 520-8200

Mailing Location

3500 Depauw Blvd Ste 3070, Indianapolis, IN 46268-6135

(317) 520-8200

Provider Taxonomies

Code	Description	License
Code 106S00000X Primary	Description Behavior Technician Behavioral Health & Social Service Providers	License RBT-17-32661 Indiana