Provider Demographics
NPI:1417620964
Name:BLUESTONE HOME CARE LLC
Entity Type:Organization
Organization Name:BLUESTONE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DIDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMA
Authorized Official - Suffix:
Authorized Official - Credentials:DSP
Authorized Official - Phone:207-409-8560
Mailing Address - Street 1:44 COBURN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5210
Mailing Address - Country:US
Mailing Address - Phone:207-409-8560
Mailing Address - Fax:
Practice Address - Street 1:44 COBURN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5210
Practice Address - Country:US
Practice Address - Phone:207-409-8560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities