Provider Demographics
NPI:1972193712
Name:BLUE HERON HEALTH AND REHABILITATION LLC
Entity Type:Organization
Organization Name:BLUE HERON HEALTH AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-664-5400
Mailing Address - Street 1:1800 N WABASH RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1300
Mailing Address - Country:US
Mailing Address - Phone:765-664-5400
Mailing Address - Fax:765-664-5403
Practice Address - Street 1:5085 EAGLESTON BOULEVARD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544
Practice Address - Country:US
Practice Address - Phone:813-454-0513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility