Provider Demographics
NPI:1003054529
Name:BLESSED HOME PROVIDER SERVICE, LLC
Entity Type:Organization
Organization Name:BLESSED HOME PROVIDER SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ALECIA
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:302-275-5707
Mailing Address - Street 1:13 BLYTH CT
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-3734
Mailing Address - Country:US
Mailing Address - Phone:302-275-5707
Mailing Address - Fax:302-276-2904
Practice Address - Street 1:13 BLYTH CT
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-3734
Practice Address - Country:US
Practice Address - Phone:302-275-5707
Practice Address - Fax:302-276-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2006207238251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health