Provider Demographics
NPI:1598193930
Name:BLUE RIDGE HOME HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:BLUE RIDGE HOME HEALTH CARE SERVICES INC
Other - Org Name:BLUE RIDGE HOME HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TUNJI
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:OGUNMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-457-4950
Mailing Address - Street 1:1310 W ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2033
Mailing Address - Country:US
Mailing Address - Phone:215-457-4950
Mailing Address - Fax:215-329-8808
Practice Address - Street 1:1310 W ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2033
Practice Address - Country:US
Practice Address - Phone:215-457-4950
Practice Address - Fax:215-329-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04800501251B00000X, 251E00000X, 251J00000X, 253Z00000X
PA23033601251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102817836Medicaid
PA04800501OtherHOME HEALTHCARE LICENSE
PA23033601OtherHOME CARE LICENSE
PA102817836Medicare Oscar/Certification