MEDICARE: BLAKE BOOTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	372600000X	Adult Companion	NE
2	3747P1801X	Personal Care Attendant	NE
3	372500000X	Chore Provider	NE

General Provider Information

NPI Number	:	1295540565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLAKE BOOTH

Provider Business Mailing Address
First Line	:	3717 27TH ST APT B31
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2239
Country	:	US
Telephone Number	:	531-230-9791
Fax Number	:

Provider Business Practice Location Address
First Line	:	3717 27TH ST APT B31
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2239
Country	:	US
Telephone Number	:	531-230-9791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2025
Last Update Date	:	02/12/2025

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Directions to “ BLAKE BOOTH ” Practice Location

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