Provider Demographics
NPI:1508475351
Name:BLUE HORIZON HEALTHCARE
Entity Type:Organization
Organization Name:BLUE HORIZON HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:510-304-9727
Mailing Address - Street 1:2654 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1512
Mailing Address - Country:US
Mailing Address - Phone:510-304-9727
Mailing Address - Fax:
Practice Address - Street 1:5509 PARKER DR
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9767
Practice Address - Country:US
Practice Address - Phone:510-304-9727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health