Provider Demographics
NPI:1730279480
Name:BLUE VALLEY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:BLUE VALLEY HEALTH CARE, INC.
Other - Org Name:CAMBRIDGE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-562-5321
Mailing Address - Street 1:1100 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1126
Mailing Address - Country:US
Mailing Address - Phone:785-562-5321
Mailing Address - Fax:785-562-5398
Practice Address - Street 1:1100 N 16TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1126
Practice Address - Country:US
Practice Address - Phone:785-562-5321
Practice Address - Fax:785-562-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN0580003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1042116201Medicaid
KS175350Medicare Oscar/Certification