Provider Demographics
NPI:1821488339
Name:BLUE WATER HOSPICE INC
Entity Type:Organization
Organization Name:BLUE WATER HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-220-1499
Mailing Address - Street 1:12361 LEWIS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4617
Mailing Address - Country:US
Mailing Address - Phone:657-465-5381
Mailing Address - Fax:657-465-5382
Practice Address - Street 1:12361 LEWIS ST STE 201
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4617
Practice Address - Country:US
Practice Address - Phone:657-465-5381
Practice Address - Fax:657-465-5382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based