Provider Demographics
NPI:1023698065
Name:BLUE HORIZONS ASSISTED LIVING HOME LLC
Entity type:Organization
Organization Name:BLUE HORIZONS ASSISTED LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAZVAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUMITRU
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:602-292-8855
Mailing Address - Street 1:16942 W BRISTOL LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0804
Mailing Address - Country:US
Mailing Address - Phone:602-292-8855
Mailing Address - Fax:888-239-1897
Practice Address - Street 1:16942 W BRISTOL LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-0804
Practice Address - Country:US
Practice Address - Phone:602-292-8855
Practice Address - Fax:888-239-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility