Provider Demographics
NPI:1194251736
Name:BLUE ROSE LEGACY HOME CARE, LLC
Entity type:Organization
Organization Name:BLUE ROSE LEGACY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTILIER-REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-867-4082
Mailing Address - Street 1:PO BOX 1442
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-1008
Mailing Address - Country:US
Mailing Address - Phone:520-867-4082
Mailing Address - Fax:866-207-2325
Practice Address - Street 1:7344 E GLACIER PARK CT
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-9466
Practice Address - Country:US
Practice Address - Phone:520-867-4082
Practice Address - Fax:866-207-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care