Healthcare Provider Details

I. General information

NPI: 1487600102
Provider Name (Legal Business Name): BLUE WATER HOME HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34051 GRATIOT AVE SUITE 103
CLINTON TWP. MI
48035-3592
US

IV. Provider business mailing address

34051 GRATIOT AVE. SUITE 103
CLINTON TWP. MI
48035-3592
US

V. Phone/Fax

Practice location:
  • Phone: 586-415-7700
  • Fax: 586-415-7800
Mailing address:
  • Phone: 586-415-7700
  • Fax: 586-415-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAHID MUNIR
Title or Position: OWNER (PRESIDENT)
Credential:
Phone: 586-415-7700