Provider Demographics
NPI:1942669304
Name:BLUE OVAL LLC
Entity Type:Organization
Organization Name:BLUE OVAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:VAMAN
Authorized Official - Last Name:SARAPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-880-2698
Mailing Address - Street 1:435 NICHOLS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2036
Mailing Address - Country:US
Mailing Address - Phone:844-521-2345
Mailing Address - Fax:844-521-2345
Practice Address - Street 1:435 NICHOLS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2036
Practice Address - Country:US
Practice Address - Phone:844-521-2345
Practice Address - Fax:844-521-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-14
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health