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General NPI Number Information
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NPI Number | 1255099131
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Entity Type | Organization
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Legal Business Name | BLUE DRAGONFLY CARE LLC
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 654 W PLATA AVE
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City | MESA
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State | AZ
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Zip | 85210-8331
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Country | US
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Telephone | 480-347-0738
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Fax |
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Provider Business Mailing Address
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Address Line | 654 W PLATA AVE
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City | MESA
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State | AZ
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Zip | 85210-8331
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Country | US
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Telephone | 480-347-0738
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | PATRICIA LYNN WOODWARD
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Credential |
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Telephone | 480-347-0738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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