Provider Demographics
NPI:1437451200
Name:BOYETTE HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:BOYETTE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOYETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:850-313-7850
Mailing Address - Street 1:8944 JOHN HAMM RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-8331
Mailing Address - Country:US
Mailing Address - Phone:850-313-7850
Mailing Address - Fax:850-983-1369
Practice Address - Street 1:8944 JOHN HAMM RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-8331
Practice Address - Country:US
Practice Address - Phone:850-313-7850
Practice Address - Fax:850-983-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002705400Medicaid
FL002090500Medicaid
FL002706400Medicaid