MEDICARE: BLUE HORIZONS GROUP HEALTH SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QH0100X	Health Service Clinic/Center
2	251300000X	Local Education Agency (LEA)
3	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1346903549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE HORIZONS GROUP HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	4317 BONNEY RD # 4
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1235
Country	:	US
Telephone Number	:	757-920-9120
Fax Number	:

Provider Business Practice Location Address
First Line	:	4317 BONNEY RD # 4
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1235
Country	:	US
Telephone Number	:	757-920-9120
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JANAE GRAHAM BRIGHT
Credential	:	LPN
Telephone Number	:	757-920-9120

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	10/20/2021

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