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General NPI Number Information
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NPI Number | 1558176750
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Entity Type | Organization
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Legal Business Name | BLUE PINE AI LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 10031 N BASALT DR
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City | HIGHLAND
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State | UT
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Zip | 84003-6000
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Country | US
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Telephone | 801-651-6490
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Fax |
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Provider Business Mailing Address
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Address Line | 10031 N BASALT DR
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City | HIGHLAND
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State | UT
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Zip | 84003-6000
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Country | US
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Telephone | 801-651-6490
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | JACKSON TODD MCCHESNEY
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Credential |
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Telephone | 801-651-6490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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