Provider Demographics
NPI:1205130267
Name:BLUE RIVER SERVICES, INC.
Entity type:Organization
Organization Name:BLUE RIVER SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-738-2408
Mailing Address - Street 1:1365 N OLD HIGHWAY 135
Mailing Address - Street 2:P.O. BOX 547
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2007
Mailing Address - Country:US
Mailing Address - Phone:812-738-2408
Mailing Address - Fax:812-738-6281
Practice Address - Street 1:1365 N OLD HIGHWAY 135
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2007
Practice Address - Country:US
Practice Address - Phone:812-738-2408
Practice Address - Fax:812-738-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty