Provider Demographics
NPI:1033770409
Name:BLESSED HOME SERVICE, LLC
Entity Type:Organization
Organization Name:BLESSED HOME SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAJIBE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ILLA-EL DIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-220-8855
Mailing Address - Street 1:630 N 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7407
Mailing Address - Country:US
Mailing Address - Phone:305-220-8855
Mailing Address - Fax:
Practice Address - Street 1:630 N 70TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7407
Practice Address - Country:US
Practice Address - Phone:305-220-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1548829401Medicaid