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General NPI Number Information
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NPI Number | 1083508063
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Entity Type | Organization
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Legal Business Name | THE DIFFERENCE 757
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 115 DIGGS DR
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City | HAMPTON
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State | VA
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Zip | 23666-1757
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Country | US
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Telephone | 757-775-0113
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 MCLEOD DR STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89121-2257
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Country | US
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Telephone | 757-775-0113
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JENNINE ROCHELLE BOOTH
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Credential |
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Telephone | 757-775-0113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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