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General NPI Number Information
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NPI Number | 1598193930
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE HOME CARE, INC
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Dates
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Enumeration Date | 10/22/2013
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1310 W ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2033
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Country | US
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Telephone | 215-457-4950
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Fax | 215-329-8808
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Provider Business Mailing Address
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Address Line | 1310 W ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19140-2033
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Country | US
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Telephone | 215-457-4950
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Fax | 215-329-8808
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Authorized Official
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Title or Position | PRESIDENT
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Name | TUNJI OGUNMOLA
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Credential | MSW
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Telephone | 215-457-4950
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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 | 04800501
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 04800501
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 23033601
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 04800501
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 04800501
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 23033601
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License Number State | PA
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