Provider Demographics
NPI:1750442026
Name:BLUE HILLS REST HOME INC.
Entity type:Organization
Organization Name:BLUE HILLS REST HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:816-796-3376
Mailing Address - Street 1:2207 N BLUE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64058-2022
Mailing Address - Country:US
Mailing Address - Phone:816-796-3376
Mailing Address - Fax:816-796-5646
Practice Address - Street 1:2207 N BLUE MILLS RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-2022
Practice Address - Country:US
Practice Address - Phone:816-796-3376
Practice Address - Fax:816-796-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033489310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility