Provider Demographics
NPI:1407553134
Name:BLUE WATER HOMECARE INC.
Entity Type:Organization
Organization Name:BLUE WATER HOMECARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:512-872-2955
Mailing Address - Street 1:660 S BAGDAD RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-5291
Mailing Address - Country:US
Mailing Address - Phone:512-872-2955
Mailing Address - Fax:512-649-9072
Practice Address - Street 1:660 S BAGDAD RD STE 210
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-5291
Practice Address - Country:US
Practice Address - Phone:512-872-2955
Practice Address - Fax:512-649-9072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE WATER SENIOR CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care