Provider Demographics
NPI:1023569837
Name:BLESSED WITH GOODNESS, LLC
Entity Type:Organization
Organization Name:BLESSED WITH GOODNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AFRICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-404-1169
Mailing Address - Street 1:716 E. FAIRFIELD ROAD
Mailing Address - Street 2:UNIT 120 (MAILBOX # 14)
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605
Mailing Address - Country:US
Mailing Address - Phone:864-520-8213
Mailing Address - Fax:864-520-8214
Practice Address - Street 1:716 E. FAIRFIELD ROAD
Practice Address - Street 2:UNIT 120 (MAILBOX # 14)
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605
Practice Address - Country:US
Practice Address - Phone:864-520-8213
Practice Address - Fax:864-520-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX1561Medicaid