Provider Demographics
NPI:1952767824
Name:BLUEHAVEN NURSING HOME CARE AGENCY INC
Entity type:Organization
Organization Name:BLUEHAVEN NURSING HOME CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHADRA
Authorized Official - Middle Name:YUSUF
Authorized Official - Last Name:HAJJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-553-8812
Mailing Address - Street 1:33 S JAMES RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1065
Mailing Address - Country:US
Mailing Address - Phone:951-553-8812
Mailing Address - Fax:
Practice Address - Street 1:33 S JAMES RD
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1065
Practice Address - Country:US
Practice Address - Phone:951-553-8812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201535701270251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health