Healthcare Provider Details

I. General information

NPI: 1609712553
Provider Name (Legal Business Name): BLUE HORIZON RESIDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18408 HOLLAND HOUSE LOOP
LAND O LAKES FL
34638-8143
US

IV. Provider business mailing address

18408 HOLLAND HOUSE LOOP
LAND O LAKES FL
34638-8143
US

V. Phone/Fax

Practice location:
  • Phone: 727-667-4815
  • Fax:
Mailing address:
  • Phone: 727-667-4815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CARMEL ALAMBAN
Title or Position: MANAGING PARTNER
Credential: APRN
Phone: 727-667-4815