BOLD ARK LLC
NPI 1740079623
Nurse Practitioner - Psychiatric/Mental Health in Loganville, GA
About Bold Ark Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BOLD ARK LLC (NPI 1740079623) is a healthcare organization registered as a psychiatric/mental health in Loganville, Georgia and active in the NPI registry since May 2025. The organization lists Olufunke Mukomi Adewunmi, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Bold Ark Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Bold Ark LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Bold Ark LLC's NPI number?
The NPI number for Bold Ark LLC is 1740079623. It was assigned to this organization in the NPPES registry on May 6, 2025.
Where is Bold Ark LLC located?
Bold Ark LLC is located at 3905 Harrison Rd Ste 500, Loganville, GA 30052. The listed phone number is (678) 898-1927.
What is Bold Ark LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.
Is Bold Ark LLC enrolled in Medicare?
Yes. Bold Ark LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Bold Ark LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Bold Ark LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Bold Ark LLC was last updated on March 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Bold Ark Llc · NPI 1740079623
Psychiatric/Mental Health organization in Loganville, Georgia. Organization record, active in the CMS NPPES registry since May 6, 2025.
## Identity
- **NPI:** 1740079623 (Entity type: Organization)
- **Enumerated:** May 6, 2025
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **Organization subpart:** No
- **Authorized official:** Olufunke Adewunmi, CEO
## Practice location
- **Address:** 3905 HARRISON RD STE 500, Loganville, GA 30052-5895
- **Phone:** (678) 898-1927 · **Fax:** (678) 798-8880
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 27, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1740079623) · Data from the CMS NPPES public registry.