MEDICARE: ANNE BLUE HOME HEALTH CARE AGENCY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	9837L001	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639377286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNE BLUE HOME HEALTH CARE AGENCY

Provider Business Mailing Address
First Line	:	21880 99TH AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11429-1206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4708 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3210
Country	:	US
Telephone Number	:	718-462-2020
Fax Number	:	172-462-7699

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. HYACINTH U BLUE
Credential	:
Telephone Number	:	718-462-2020

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	05/16/2008

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