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General NPI Number Information
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NPI Number | 1710577051
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Entity Type | Organization
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Legal Business Name | BLUE CARE HOME CARE, LLC
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 204 STATELINE RD W
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City | SOUTHAVEN
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State | MS
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Zip | 38671-1608
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Country | US
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Telephone | 662-253-8543
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1593
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City | SOUTHAVEN
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State | MS
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Zip | 38671-0017
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Country | US
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Telephone | 662-253-8543
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DONNA LUCKETT
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Credential | FNP
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Telephone | 662-253-8543
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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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