MEDICARE: BLUEHEART ADULT DAY CARE CENTER

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1740825801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEHEART ADULT DAY CARE CENTER

Provider Business Mailing Address
First Line	:	1917 MONTAGUE ST
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33461-6057
Country	:	US
Telephone Number	:	561-352-9728
Fax Number	:

Provider Business Practice Location Address
First Line	:	1917 MONTAGUE ST
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33461-6057
Country	:	US
Telephone Number	:	561-352-9728
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLETHA EDNETTA BLUE
Credential	:	OWNER
Telephone Number	:	561-352-9728

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	12/22/2023

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