Provider Demographics
NPI:1366839714
Name:BOUNTIFUL BLESSINGS, LLC
Entity Type:Organization
Organization Name:BOUNTIFUL BLESSINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERNITA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-479-6674
Mailing Address - Street 1:126 FLORA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1025
Mailing Address - Country:US
Mailing Address - Phone:314-833-9661
Mailing Address - Fax:
Practice Address - Street 1:126 FLORA DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63135-1025
Practice Address - Country:US
Practice Address - Phone:314-833-9661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1246251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services