Provider Demographics
NPI:1225837297
Name:HYDRA BLU HOME HEALTH AND SUPPORTIVE LIVING SERVICES
Entity type:Organization
Organization Name:HYDRA BLU HOME HEALTH AND SUPPORTIVE LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:VELITA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:220-219-6722
Mailing Address - Street 1:4156 VIRGINIA CIR E
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2826
Mailing Address - Country:US
Mailing Address - Phone:220-219-6722
Mailing Address - Fax:
Practice Address - Street 1:4156 VIRGINIA CIR E
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2826
Practice Address - Country:US
Practice Address - Phone:220-219-6722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care