Provider Demographics
NPI:1730779976
Name:BLUE HILL HEALTH COLLABORATIVE LLC
Entity type:Organization
Organization Name:BLUE HILL HEALTH COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARYL
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:HEATON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-207-1693
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:EAST BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04629-0042
Mailing Address - Country:US
Mailing Address - Phone:201-207-1693
Mailing Address - Fax:207-374-5791
Practice Address - Street 1:809 E BLUE HILL RD
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5414
Practice Address - Country:US
Practice Address - Phone:201-207-1693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care