Provider Demographics
NPI:1093110546
Name:BLESSED HOMECARE LLC
Entity Type:Organization
Organization Name:BLESSED HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEATHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:615-456-4013
Mailing Address - Street 1:219 EVERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2944
Mailing Address - Country:US
Mailing Address - Phone:615-456-4013
Mailing Address - Fax:
Practice Address - Street 1:219 EVERGREEN CIR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2944
Practice Address - Country:US
Practice Address - Phone:615-456-4013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN671766302R00000X, 305S00000X
TN0000002538311ZA0620X, 385H00000X
TN087330800347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305S00000XManaged Care OrganizationsPoint of Service
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care