Provider Demographics
NPI:1285677930
Name:BOOTHEEL IN-HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:BOOTHEEL IN-HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:VERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-616-7732
Mailing Address - Street 1:311 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW MADRID
Mailing Address - State:MO
Mailing Address - Zip Code:63869-1942
Mailing Address - Country:US
Mailing Address - Phone:573-748-5905
Mailing Address - Fax:573-748-5795
Practice Address - Street 1:311 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MADRID
Practice Address - State:MO
Practice Address - Zip Code:63869-1942
Practice Address - Country:US
Practice Address - Phone:573-748-5905
Practice Address - Fax:573-748-5795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-6165208Medicaid