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General NPI Number Information
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NPI Number | 1386067346
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Entity Type | Organization
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Legal Business Name | BLUE CROSS HOME CARE
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 9000 E JEFFERSON AVE STE 14-2
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City | DETROIT
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State | MI
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Zip | 48214-4188
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Country | US
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Telephone | 954-601-6117
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 E JEFFERSON AVE STE 14-2
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City | DETROIT
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State | MI
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Zip | 48214-4188
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | PENNY GRAY
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Credential |
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Telephone | 941-377-7622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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