Provider Demographics
NPI:1346689221
Name:BLESSED HOME AFC SERVICES, LLC
Entity Type:Organization
Organization Name:BLESSED HOME AFC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADENIYI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ND
Authorized Official - Phone:269-684-2668
Mailing Address - Street 1:1217 STATELINE RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-4729
Mailing Address - Country:US
Mailing Address - Phone:269-684-2668
Mailing Address - Fax:269-683-8986
Practice Address - Street 1:1217 STATELINE RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-4729
Practice Address - Country:US
Practice Address - Phone:269-684-2668
Practice Address - Fax:269-683-8986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL 110238445320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities