Provider Demographics
NPI:1598400707
Name:BLUE HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:BLUE HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:NNAMDI
Authorized Official - Last Name:IBEZIAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-426-0280
Mailing Address - Street 1:1900 E MAIN STREET
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-426-0280
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN STREET
Practice Address - Street 2:SUITE 112
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-426-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care