Organization
BLUE HAYVEN IN HOME HEALTH CARE LLC
Active
Other names
Blue Hayven In Home Health Care LLC
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE M BROCK-WILLIAMS (DIRECTOR)
(314) 440-8087
Entity
Organization
Contact information
Practice address
11553 WITHERSFIELD DR, SAINT LOUIS, MO 63138-1152
(314) 440-8087
Mailing address
11553 WITHERSFIELD DR, SAINT LOUIS, MO 63138-1152
(314) 440-8087
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
—
MO
302R00000X
Health Maintenance Organization
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
04/07/2011
Last updated
04/07/2011
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