Provider Demographics
NPI:1083438923
Name:BLAINE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:BLAINE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALENTINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:OBWOGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-318-5008
Mailing Address - Street 1:13250 NASSAU CT NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4989
Mailing Address - Country:US
Mailing Address - Phone:763-318-5008
Mailing Address - Fax:
Practice Address - Street 1:13250 NASSAU CT NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4989
Practice Address - Country:US
Practice Address - Phone:763-318-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient