Provider Demographics
NPI:1811463896
Name:BLUE WATER HOME HEALTH INC
Entity type:Organization
Organization Name:BLUE WATER HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:REZA RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-716-1305
Mailing Address - Street 1:10568 MAGNOLIA AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5864
Mailing Address - Country:US
Mailing Address - Phone:714-716-1305
Mailing Address - Fax:714-716-1385
Practice Address - Street 1:10568 MAGNOLIA AVE STE 122
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5864
Practice Address - Country:US
Practice Address - Phone:714-716-1305
Practice Address - Fax:714-716-1385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health