Healthcare Provider Details

I. General information

NPI: 1336620756
Provider Name (Legal Business Name): BLUE RIDGE HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E LOOCKERMAN ST STE 211
DOVER DE
19901-7347
US

IV. Provider business mailing address

9 E LOOCKERMAN ST STE 211
DOVER DE
19901-7347
US

V. Phone/Fax

Practice location:
  • Phone: 302-397-8211
  • Fax: 302-510-4627
Mailing address:
  • Phone: 302-397-8211
  • Fax: 302-510-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TUNJI ISAAC OGUNMOLA
Title or Position: PRESIDENT
Credential: MSW
Phone: 215-457-4950