MEDICARE: THE DIFFERENCE 757

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	385H00000X	Respite Care
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1083508063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DIFFERENCE 757

Provider Business Mailing Address
First Line	:	3225 MCLEOD DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2257
Country	:	US
Telephone Number	:	757-775-0113
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 DIGGS DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1757
Country	:	US
Telephone Number	:	757-775-0113
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNINE ROCHELLE BOOTH
Credential	:
Telephone Number	:	757-775-0113

Provider Enumeration Date	:	06/05/2025
Last Update Date	:	06/26/2025

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Directions to “THE DIFFERENCE 757 ” Practice Location

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