Provider Demographics
NPI:1811169121
Name:BLUE ANGEL HOME CARE LLC
Entity type:Organization
Organization Name:BLUE ANGEL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:SHINA
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:248-809-2906
Mailing Address - Street 1:3986 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4724
Mailing Address - Country:US
Mailing Address - Phone:248-809-2906
Mailing Address - Fax:248-809-2907
Practice Address - Street 1:1000 JOHN R RD
Practice Address - Street 2:SUITE 212
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5852
Practice Address - Country:US
Practice Address - Phone:248-809-2906
Practice Address - Fax:248-809-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-9081Medicare UPIN