Provider Demographics
NPI:1033932132
Name:BLUE MOUNTAIN HEALTH CARE LLC
Entity type:Organization
Organization Name:BLUE MOUNTAIN HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BELAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLITHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-241-1960
Mailing Address - Street 1:32685 US HIGHWAY 281 N STE 140
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-3272
Mailing Address - Country:US
Mailing Address - Phone:830-980-3777
Mailing Address - Fax:866-598-4096
Practice Address - Street 1:32685 US HIGHWAY 281 N STE 140
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3272
Practice Address - Country:US
Practice Address - Phone:830-980-3777
Practice Address - Fax:866-598-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty