Organization
BLUE CREEK HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL B BERGSTEN (MANAGING MEMBER)
(937) 825-6622
Entity
Organization
Contact information
Practice address
11239 WATERVILLE ST, WHITEHOUSE, OH 43571-9813
(937) 825-6622
Mailing address
544 ENTERPRISE DR, LEWIS CENTER, OH 43035-9704
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
12/07/2017
Last updated
12/07/2017
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