Provider Demographics
NPI:1275786436
Name:BLESSED ASSURANCE HOME CARE LLC
Entity Type:Organization
Organization Name:BLESSED ASSURANCE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:517-393-9201
Mailing Address - Street 1:PO BOX 27302
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-7302
Mailing Address - Country:US
Mailing Address - Phone:517-393-9201
Mailing Address - Fax:517-393-5547
Practice Address - Street 1:2400 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-4860
Practice Address - Country:US
Practice Address - Phone:517-393-9201
Practice Address - Fax:517-393-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703061419251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI100004361092Medicaid