Provider Demographics
NPI:1750142378
Name:BLUE ANGEL VENTURES INC.
Entity type:Organization
Organization Name:BLUE ANGEL VENTURES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:508-780-0031
Mailing Address - Street 1:30 S WASHINGTON ST # 510
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1649
Mailing Address - Country:US
Mailing Address - Phone:774-563-3785
Mailing Address - Fax:
Practice Address - Street 1:51 MAN MAR DR UNIT 4
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2272
Practice Address - Country:US
Practice Address - Phone:508-780-0031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No385H00000XRespite Care FacilityRespite Care