MEDICARE: OLETHA EDNETTA BLUE

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	251E00000X	Home Health Agency	237709	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	B400645796870	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	B400645796870	OTHER	FL	01

General Provider Information

NPI Number	:	1427627496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLETHA EDNETTA BLUE

Provider Business Mailing Address
First Line	:	1917 MONTAGUE ST
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33461-6057
Country	:	US
Telephone Number	:	156-135-2972
Fax Number	:

Provider Business Practice Location Address
First Line	:	1917 MONTAGUE ST
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33461-6057
Country	:	US
Telephone Number	:	156-135-2972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	01/27/2025

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Directions to “ OLETHA EDNETTA BLUE ” Practice Location

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