Provider Demographics
NPI:1164180725
Name:BLUE HORIZON HOME CARE, LLC
Entity Type:Organization
Organization Name:BLUE HORIZON HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHINASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-710-8411
Mailing Address - Street 1:PO BOX 3325
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-3325
Mailing Address - Country:US
Mailing Address - Phone:480-710-8411
Mailing Address - Fax:
Practice Address - Street 1:06 LAMBDA ST
Practice Address - Street 2:SP 1
Practice Address - City:MENTMORE
Practice Address - State:NM
Practice Address - Zip Code:87319-8731
Practice Address - Country:US
Practice Address - Phone:480-710-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty