Provider Demographics
NPI:1548914906
Name:BLUELILIES HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:BLUELILIES HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAKUNLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-689-0231
Mailing Address - Street 1:2111 ABUNDANCE LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-0352
Mailing Address - Country:US
Mailing Address - Phone:817-689-0231
Mailing Address - Fax:704-684-5228
Practice Address - Street 1:6746 LENNOX ST
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-5518
Practice Address - Country:US
Practice Address - Phone:817-689-0231
Practice Address - Fax:704-684-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No385H00000XRespite Care FacilityRespite Care