Provider Demographics
NPI:1366284846
Name:BLUE ANGELS HEALTHCARE SERVICES.LLC
Entity type:Organization
Organization Name:BLUE ANGELS HEALTHCARE SERVICES.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KOISAU
Authorized Official - Middle Name:KISSES
Authorized Official - Last Name:MORLU
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:571-238-2803
Mailing Address - Street 1:3500 AMOS DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3774
Mailing Address - Country:US
Mailing Address - Phone:571-238-2803
Mailing Address - Fax:
Practice Address - Street 1:3500 AMOS DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3774
Practice Address - Country:US
Practice Address - Phone:571-238-2803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No385HR2050XRespite Care FacilityRespite CareRespite Care CampGroup - Multi-Specialty