Healthcare Provider Details

I. General information

NPI: 1962894717
Provider Name (Legal Business Name): BLUESTAR HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5613 LEESBURG PIKE STE 55
FALLS CHURCH VA
22041-2912
US

IV. Provider business mailing address

5613 LEESBURG PIKE STE 55
FALLS CHURCH VA
22041-2912
US

V. Phone/Fax

Practice location:
  • Phone: 703-829-0719
  • Fax: 703-646-7558
Mailing address:
  • Phone: 703-829-0719
  • Fax: 703-646-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number171347
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number171347
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number171347
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ISMAHAN AHMED
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 703-829-0719