Provider Demographics
NPI:1083508063
Name:THE DIFFERENCE 757
Entity type:Organization
Organization Name:THE DIFFERENCE 757
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNINE
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-775-0113
Mailing Address - Street 1:3225 MCLEOD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2257
Mailing Address - Country:US
Mailing Address - Phone:757-775-0113
Mailing Address - Fax:
Practice Address - Street 1:115 DIGGS DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1757
Practice Address - Country:US
Practice Address - Phone:757-775-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENBRIAR PLACE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care