Provider Demographics
NPI:1689816050
Name:BLUE WATER ENDEAVORS, INC.
Entity Type:Organization
Organization Name:BLUE WATER ENDEAVORS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICAFORT
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:310-263-7185
Mailing Address - Street 1:13405 INGLEWOOD AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5646
Mailing Address - Country:US
Mailing Address - Phone:310-263-7185
Mailing Address - Fax:310-263-7232
Practice Address - Street 1:13405 INGLEWOOD AVENUE
Practice Address - Street 2:SUITE 6
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90254
Practice Address - Country:US
Practice Address - Phone:310-263-7185
Practice Address - Fax:310-263-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health