| Organization Name: | BLUEWATER HOUSE LLC |
| NPI Number: | 1174902902 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TICE RIDLEY (CEO) |
| Mailing Address: | 19717 Bower Rd Dade City |
| State: | FL US |
| Postal Code: | 335236867 |
| Phone Number: | 7738599006 |
| Fax Number: | 7274997526 |
| NPI Enumeration Date: | 05/26/2015 |
| NPI Last Update Date: | 05/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | PY 5540 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |