Provider Demographics
NPI:1538785548
Name:BLUE RIDGE HOME CARE, INC.
Entity type:Organization
Organization Name:BLUE RIDGE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TUNJI
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:OGUNMOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:646-963-6112
Mailing Address - Street 1:1059 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2511
Mailing Address - Country:US
Mailing Address - Phone:646-963-6112
Mailing Address - Fax:646-963-6114
Practice Address - Street 1:1059 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2511
Practice Address - Country:US
Practice Address - Phone:646-963-6112
Practice Address - Fax:646-963-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care