Provider Demographics
NPI:1114785219
Name:BLESSED PROVIDER SERVICES LLC
Entity Type:Organization
Organization Name:BLESSED PROVIDER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROEL
Authorized Official - Middle Name:ADRIAN
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-756-1279
Mailing Address - Street 1:611 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-2961
Mailing Address - Country:US
Mailing Address - Phone:361-949-5246
Mailing Address - Fax:
Practice Address - Street 1:611 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-2961
Practice Address - Country:US
Practice Address - Phone:361-949-5246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health