Provider Demographics
NPI:1992710693
Name:BLUESTAR HOME HEALTH LLC
Entity type:Organization
Organization Name:BLUESTAR HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-676-3701
Mailing Address - Street 1:45 W SEGO LILY DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3299
Mailing Address - Country:US
Mailing Address - Phone:801-433-0344
Mailing Address - Fax:801-433-0075
Practice Address - Street 1:45 W SEGO LILY DR
Practice Address - Street 2:SUITE 401
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3299
Practice Address - Country:US
Practice Address - Phone:801-433-0344
Practice Address - Fax:801-433-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid