Provider Demographics
NPI:1588250013
Name:BLTR FL LLC
Entity type:Organization
Organization Name:BLTR FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-674-7023
Mailing Address - Street 1:12995 S CLEVELAND AVE STE 252
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7714
Mailing Address - Country:US
Mailing Address - Phone:239-236-7238
Mailing Address - Fax:239-791-8085
Practice Address - Street 1:12995 S CLEVELAND AVE STE 252
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7714
Practice Address - Country:US
Practice Address - Phone:239-236-7238
Practice Address - Fax:239-791-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health