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General NPI Number Information
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NPI Number | 1023698065
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Entity Type | Organization
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Legal Business Name | BLUE HORIZONS ASSISTED LIVING HOME LLC
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 16942 W BRISTOL LN
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City | SURPRISE
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State | AZ
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Zip | 85374-0804
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Country | US
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Telephone | 602-292-8855
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Fax | 888-239-1897
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Provider Business Mailing Address
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Address Line | 16942 W BRISTOL LN
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City | SURPRISE
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State | AZ
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Zip | 85374-0804
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Country | US
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Telephone | 602-292-8855
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Fax | 888-239-1897
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Authorized Official
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Title or Position | MANAGER
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Name | RAZVAN C DUMITRU
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Credential | MANAGER
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Telephone | 602-292-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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