Provider Demographics
NPI:1356162952
Name:THE BLUE TREE CAFE LIMITED LIABILITY CO.
Entity type:Organization
Organization Name:THE BLUE TREE CAFE LIMITED LIABILITY CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:786-239-9131
Mailing Address - Street 1:2701 TARPON DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4524
Mailing Address - Country:US
Mailing Address - Phone:786-239-9131
Mailing Address - Fax:
Practice Address - Street 1:612 NW 9TH AVE STE A
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7674
Practice Address - Country:US
Practice Address - Phone:786-239-9131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
No332U00000XSuppliersHome Delivered Meals
No335G00000XSuppliersMedical Foods Supplier
No251300000XAgenciesLocal Education Agency (LEA)