Provider Demographics
NPI:1396442554
Name:BLUE LINE COMMUNITY SERVICES LLC
Entity type:Organization
Organization Name:BLUE LINE COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KRZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-800-0013
Mailing Address - Street 1:1002 TOLTEC TRL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7053
Mailing Address - Country:US
Mailing Address - Phone:512-800-0013
Mailing Address - Fax:
Practice Address - Street 1:1002 TOLTEC TRL
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7053
Practice Address - Country:US
Practice Address - Phone:512-800-0013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities