Provider Demographics
NPI:1700924115
Name:BLJ HEALTHCARE AND SERVICE CORP
Entity Type:Organization
Organization Name:BLJ HEALTHCARE AND SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDECIA GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-834-6088
Mailing Address - Street 1:PO BOX 1417
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1417
Mailing Address - Country:US
Mailing Address - Phone:787-834-6088
Mailing Address - Fax:787-833-5633
Practice Address - Street 1:CALLE MEDITACION 53
Practice Address - Street 2:ESQUINA PERAL
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-6088
Practice Address - Fax:787-833-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4836260001Medicare NSC