Provider Demographics
NPI:1679226401
Name:BLUE NILE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:BLUE NILE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGHOUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-356-8573
Mailing Address - Street 1:4380 KING ST APT 807
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1544
Mailing Address - Country:US
Mailing Address - Phone:571-719-1319
Mailing Address - Fax:
Practice Address - Street 1:4380 KING ST APT 807
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1544
Practice Address - Country:US
Practice Address - Phone:571-719-1319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty