Provider Demographics
NPI:1336620756
Name:BLUE RIDGE HOME CARE, INC
Entity Type:Organization
Organization Name:BLUE RIDGE HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TUNJI
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:OGUNMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:215-457-4950
Mailing Address - Street 1:9 E LOOCKERMAN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7347
Mailing Address - Country:US
Mailing Address - Phone:302-397-8211
Mailing Address - Fax:302-510-4627
Practice Address - Street 1:9 E LOOCKERMAN ST STE 211
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7347
Practice Address - Country:US
Practice Address - Phone:302-397-8211
Practice Address - Fax:302-510-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training ProviderGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services