Provider Demographics
NPI:1669518619
Name:AMERI BLUE HEALTHCARE SERVICES,LLC
Entity type:Organization
Organization Name:AMERI BLUE HEALTHCARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIEVIC
Authorized Official - Middle Name:REVOTE
Authorized Official - Last Name:GAVIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-271-9027
Mailing Address - Street 1:3300 S GESSNER RD
Mailing Address - Street 2:SUITE 165
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5100
Mailing Address - Country:US
Mailing Address - Phone:713-271-9027
Mailing Address - Fax:713-271-9067
Practice Address - Street 1:3300 S GESSNER RD
Practice Address - Street 2:SUITE 165
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5100
Practice Address - Country:US
Practice Address - Phone:713-271-9027
Practice Address - Fax:713-271-9067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008212251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679316Medicare ID - Type UnspecifiedPROVIDER NO.
1669518619Medicare NSC