=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851731731
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE HORIZONS HOME HEALTH CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2013
-----------------------------------------------------
Last Update Date | 09/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4959 PALO VERDE ST SUITE 201C
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91763-2331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-868-7637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7980 VANDEWATER ST
-----------------------------------------------------
City | EASTVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92880-5516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SALAMATOU O CARR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-868-7637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------