Provider Demographics
NPI:1295597193
Name:BLUE RIVER COMMERCIAL INC
Entity type:Organization
Organization Name:BLUE RIVER COMMERCIAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:YASIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELL MANZARRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-627-3161
Mailing Address - Street 1:1400 NE MIAMI GARDENS DR STE 206B
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 NE MIAMI GARDENS DR STE 206B
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4840
Practice Address - Country:US
Practice Address - Phone:305-627-3161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies