Provider Demographics
NPI:1508409293
Name:BOOST HOME HEALTH LLC
Entity Type:Organization
Organization Name:BOOST HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:715-220-3015
Mailing Address - Street 1:1198 121ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-7158
Mailing Address - Country:US
Mailing Address - Phone:715-220-3015
Mailing Address - Fax:
Practice Address - Street 1:1198 121ST AVE
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-7158
Practice Address - Country:US
Practice Address - Phone:715-220-3015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation