Provider Demographics
NPI:1710722137
Name:BLUEBERRY HILL ASSISTED LIVING INC.
Entity type:Organization
Organization Name:BLUEBERRY HILL ASSISTED LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-620-4968
Mailing Address - Street 1:PO BOX 480762
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-9362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 WALKER ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:MI
Practice Address - Zip Code:49065-9703
Practice Address - Country:US
Practice Address - Phone:269-299-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility