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General NPI Number Information
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NPI Number | 1053202242
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Entity Type | Organization
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Legal Business Name | BOOTH HOUSE PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 1 BOOTH HOUSE LN # 1B
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City | NEW MILFORD
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State | CT
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Zip | 06776-3097
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Country | US
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Telephone | 860-799-0146
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BOOTH HOUSE LN # 1B
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City | NEW MILFORD
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State | CT
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Zip | 06776-3097
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LORETTA J PACE
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Credential | AGNP-C
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Telephone | 203-558-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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