Provider Demographics
NPI:1639635436
Name:HEALTHBOOSTER AGENCY LLC
Entity Type:Organization
Organization Name:HEALTHBOOSTER AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIXON
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNEUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:352-451-2517
Mailing Address - Street 1:6511 NW 27TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-1518
Mailing Address - Country:US
Mailing Address - Phone:352-451-2517
Mailing Address - Fax:
Practice Address - Street 1:6511 NW 27TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-1518
Practice Address - Country:US
Practice Address - Phone:352-451-2517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services