Provider Demographics
NPI:1164621108
Name:BLESSED AT HOME LLC
Entity Type:Organization
Organization Name:BLESSED AT HOME LLC
Other - Org Name:BLESSED AT HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL MEMBER/VPQI
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN BIBBER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:740-574-5667
Mailing Address - Street 1:16720 US HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-8894
Mailing Address - Country:US
Mailing Address - Phone:740-574-5667
Mailing Address - Fax:740-574-5811
Practice Address - Street 1:16720 US HIGHWAY 52 UNIT C
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-8894
Practice Address - Country:US
Practice Address - Phone:740-727-8032
Practice Address - Fax:740-574-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054894Medicaid
OH368224Medicare Oscar/Certification