Provider Demographics
NPI:1942424361
Name:BLUE MOUNTAIN DEVELOPMENTAL PROGRAMS, LLC
Entity Type:Organization
Organization Name:BLUE MOUNTAIN DEVELOPMENTAL PROGRAMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:MELANIE
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:623-584-5990
Mailing Address - Street 1:13954 W WADDELL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8751
Mailing Address - Country:US
Mailing Address - Phone:623-584-5990
Mailing Address - Fax:
Practice Address - Street 1:13939 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2440
Practice Address - Country:US
Practice Address - Phone:623-584-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child