- Enrollment id
- O20250613001151
- Enrollment state
- LA
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1124843560
- Multiple npi flag
- N
- Ccn
- 197325
- Associate id
- 9234301797
- Organization name
- BLUEBONNET HEALTHCARE, INC.
- Doing business as name
- FAMILY HOME HEALTH AGENCY
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 109 NORTHPARK BLVD
- Address line 2
- SUITE 310
- City
- COVINGTON
- State
- LA
- Zip code
- 70433