Provider Demographics
NPI:1174414262
Name:BLUE CORAL HOME CARE LLC
Entity type:Organization
Organization Name:BLUE CORAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:NGUIDJOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:531-218-4903
Mailing Address - Street 1:3333 MEREDITH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2337
Mailing Address - Country:US
Mailing Address - Phone:531-218-4903
Mailing Address - Fax:
Practice Address - Street 1:3333 MEREDITH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2337
Practice Address - Country:US
Practice Address - Phone:531-218-4903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care