Healthcare Provider Details

I. General information

NPI: 1992649875
Provider Name (Legal Business Name): BLUE RIVER HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11755 FREDERICKSBURG RD NW
DEPAUW IN
47115-8229
US

IV. Provider business mailing address

11755 FREDERICKSBURG RD NW
DEPAUW IN
47115-8229
US

V. Phone/Fax

Practice location:
  • Phone: 812-267-2359
  • Fax:
Mailing address:
  • Phone: 812-267-2359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUSTINE ATKINS
Title or Position: OWNET
Credential: APRN-BC, MSN
Phone: 812-267-2359