MEDICARE: BLUE DRAGONFLY CATERING COMPANY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QA0600X	Adult Day Care Clinic/Center
2	261QM3000X	Medically Fragile Infants and Children Day Care
3	310400000X	Assisted Living Facility
4	332U00000X	Home Delivered Meals
5	385H00000X	Respite Care
6	251V00000X	Voluntary or Charitable Agency
7	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1134965460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE DRAGONFLY CATERING COMPANY INC

Provider Business Mailing Address
First Line	:	3601 MISSOURI AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3809 ARBUTUS AVE
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-6355
Country	:	US
Telephone Number	:	804-501-9945
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHANNON JAMESE MCGEE
Credential	:
Telephone Number	:	804-501-9945

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/05/2024

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