Provider Demographics
NPI:1568583193
Name:BLESSED ALMS II LLC
Entity Type:Organization
Organization Name:BLESSED ALMS II LLC
Other - Org Name:BLESSED ALMS II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR/QMHP
Authorized Official - Phone:336-734-3824
Mailing Address - Street 1:PO BOX 16527
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27416-0527
Mailing Address - Country:US
Mailing Address - Phone:336-379-1314
Mailing Address - Fax:336-379-1392
Practice Address - Street 1:3909 BEARS CREEK RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5149
Practice Address - Country:US
Practice Address - Phone:336-379-1314
Practice Address - Fax:336-379-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-691320600000X
NCMHL-041-1083320600000X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603958Medicaid