Healthcare Provider Details

I. General information

NPI: 1245194935
Provider Name (Legal Business Name): BLU FAIRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 RAMBLE WOOD CT
ROCK HILL SC
29730-7573
US

IV. Provider business mailing address

1735 HECKLE BLVD STE 103-267
ROCK HILL SC
29732-4803
US

V. Phone/Fax

Practice location:
  • Phone: 803-949-6249
  • Fax:
Mailing address:
  • Phone: 803-949-6249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LAQUEASHA HARRIS
Title or Position: OWNER & OPERATOR
Credential:
Phone: 803-949-6249