Provider Demographics
NPI:1679901128
Name:BLUE BIRD HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:BLUE BIRD HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:YEMISI
Authorized Official - Middle Name:ADETOLA
Authorized Official - Last Name:ALLEN-OYEBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:973-979-1737
Mailing Address - Street 1:1301 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5447
Mailing Address - Country:US
Mailing Address - Phone:973-979-1737
Mailing Address - Fax:908-688-0636
Practice Address - Street 1:1301 OXFORD LN
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5447
Practice Address - Country:US
Practice Address - Phone:973-979-1737
Practice Address - Fax:908-688-0636
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-19
Last Update Date:2013-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHPO180800251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health