Provider Demographics
NPI:1578846028
Name:BLUEPRINT HOME HEALTHCARE CORP.
Entity Type:Organization
Organization Name:BLUEPRINT HOME HEALTHCARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-368-0007
Mailing Address - Street 1:PO BOX 871314
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-6314
Mailing Address - Country:US
Mailing Address - Phone:888-368-0007
Mailing Address - Fax:
Practice Address - Street 1:2723 S STATE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6188
Practice Address - Country:US
Practice Address - Phone:888-572-5541
Practice Address - Fax:888-706-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies