Provider Demographics
NPI:1275178949
Name:BLESSED GROUP HOMES INC
Entity Type:Organization
Organization Name:BLESSED GROUP HOMES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BLESS
Authorized Official - Middle Name:
Authorized Official - Last Name:KETUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-505-9449
Mailing Address - Street 1:6101 MANTLEPIECE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6101 MANTLEPIECE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3239
Practice Address - Country:US
Practice Address - Phone:703-239-2069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities