Provider Demographics
NPI:1962159442
Name:BLUE HORIZON PK, INC
Entity type:Organization
Organization Name:BLUE HORIZON PK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:INGA
Authorized Official - Middle Name:
Authorized Official - Last Name:EKSYUZYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:747-298-9998
Mailing Address - Street 1:8522 FOOTHILL BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7590 N GLENOAKS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-1003
Practice Address - Country:US
Practice Address - Phone:747-298-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health