Provider Demographics
NPI:1962894717
Name:BLUESTAR HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:BLUESTAR HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ISMAHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-829-0719
Mailing Address - Street 1:5613 LEESBURG PIKE STE 55
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-2912
Mailing Address - Country:US
Mailing Address - Phone:703-829-0719
Mailing Address - Fax:703-646-7558
Practice Address - Street 1:5613 LEESBURG PIKE STE 55
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2912
Practice Address - Country:US
Practice Address - Phone:703-829-0719
Practice Address - Fax:703-646-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171347251F00000X, 251J00000X, 253Z00000X
251G00000X, 385H00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA171347OtherVA DEPARTMENT OF HEALTH
VA1962894717Medicaid