Healthcare Provider Details

I. General information

NPI: 1598529075
Provider Name (Legal Business Name): BLUE HORIZON VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 INVERRARY DR
BLUE BELL PA
19422-3253
US

IV. Provider business mailing address

133 INVERRARY DR
BLUE BELL PA
19422-3253
US

V. Phone/Fax

Practice location:
  • Phone: 251-455-9590
  • Fax:
Mailing address:
  • Phone: 251-455-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PUNEET KAUSHIK
Title or Position: CEO
Credential:
Phone: 251-455-9590