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General NPI Number Information
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NPI Number | 1164180725
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Entity Type | Organization
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Legal Business Name | BLUE HORIZON HOME CARE, LLC
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 06 LAMBDA ST SP 1
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City | MENTMORE
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State | NM
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Zip | 87319-8731
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Country | US
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Telephone | 480-710-8411
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3325
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City | GALLUP
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State | NM
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Zip | 87305-3325
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Country | US
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Telephone | 480-710-8411
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | SHINASHA BENALLY
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Credential |
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Telephone | 480-710-8411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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