MEDICARE: BLUE WATER HOME HELP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1003658501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE WATER HOME HELP LLC

Provider Business Mailing Address
First Line	:	2972 GROVES DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2972 GROVES DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3630
Country	:	US
Telephone Number	:	313-268-9060
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MONWARA RAHMAN
Credential	:
Telephone Number	:	313-268-9060

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	06/07/2024

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