Provider Demographics
NPI:1164691291
Name:JOHN BOOTH
Entity Type:Organization
Organization Name:JOHN BOOTH
Other - Org Name:CHAMPION HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-577-0355
Mailing Address - Street 1:508 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-3318
Mailing Address - Country:US
Mailing Address - Phone:903-577-0355
Mailing Address - Fax:903-577-0357
Practice Address - Street 1:508 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3318
Practice Address - Country:US
Practice Address - Phone:903-577-0355
Practice Address - Fax:903-577-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011788251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health