Provider Demographics
NPI:1538939723
Name:BLUE CASTLE BOLIVAR LLC
Entity type:Organization
Organization Name:BLUE CASTLE BOLIVAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:913-744-8430
Mailing Address - Street 1:1830 E LAVERNE ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-1488
Mailing Address - Country:US
Mailing Address - Phone:417-777-2583
Mailing Address - Fax:417-326-2584
Practice Address - Street 1:1830 E LAVERNE ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1488
Practice Address - Country:US
Practice Address - Phone:417-777-2583
Practice Address - Fax:417-326-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant