Provider Demographics
NPI:1477839082
Name:BLESSED & FAVORED ASSISTED LIVING INC.
Entity Type:Organization
Organization Name:BLESSED & FAVORED ASSISTED LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:KUTRACE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-500-8496
Mailing Address - Street 1:901 COURY RD
Mailing Address - Street 2:APT#19
Mailing Address - City:EVERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76140-4355
Mailing Address - Country:US
Mailing Address - Phone:817-500-8496
Mailing Address - Fax:
Practice Address - Street 1:1807 LOST CROSSING TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-3637
Practice Address - Country:US
Practice Address - Phone:817-500-8496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSSN/ITIN/EIN320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities