Provider Demographics
NPI:1356645931
Name:BOOTHEEL SENIOR SERVICES, INC.
Entity Type:Organization
Organization Name:BOOTHEEL SENIOR SERVICES, INC.
Other - Org Name:BOOTHEEL CONSUMER SENIOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-616-7732
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:MO
Mailing Address - Zip Code:63860-0026
Mailing Address - Country:US
Mailing Address - Phone:573-748-5905
Mailing Address - Fax:573-748-5795
Practice Address - Street 1:527 STATE HIGHWAY W
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:MO
Practice Address - Zip Code:63860
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:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty