Healthcare Provider Details

I. General information

NPI: 1740825801
Provider Name (Legal Business Name): BLUEHEART ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1917 MONTAGUE ST
LAKE WORTH BEACH FL
33461-6057
US

IV. Provider business mailing address

1917 MONTAGUE ST
LAKE WORTH BEACH FL
33461-6057
US

V. Phone/Fax

Practice location:
  • Phone: 561-352-9728
  • Fax:
Mailing address:
  • Phone: 561-352-9728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: OLETHA EDNETTA BLUE
Title or Position: OWNER
Credential: OWNER
Phone: 561-352-9728