Healthcare Provider Details

I. General information

NPI: 1922690908
Provider Name (Legal Business Name): BLUESTEM FARMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6721 LAKE HARBOUR DR
MIDLOTHIAN VA
23112-2083
US

IV. Provider business mailing address

6721 LAKE HARBOUR DR
MIDLOTHIAN VA
23112-2083
US

V. Phone/Fax

Practice location:
  • Phone: 804-739-8400
  • Fax: 804-739-5579
Mailing address:
  • Phone: 804-739-8400
  • Fax: 804-739-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: VICKIE JONES
Title or Position: OFFICE MANAGER
Credential:
Phone: 804-739-4000