Provider Demographics
NPI:1679137152
Name:BLESSED GARDENZ LLC
Entity Type:Organization
Organization Name:BLESSED GARDENZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YABA
Authorized Official - Middle Name:PHILOMENE-B
Authorized Official - Last Name:AWUAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-547-5385
Mailing Address - Street 1:1161 HACKNEE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2771
Mailing Address - Country:US
Mailing Address - Phone:678-373-3900
Mailing Address - Fax:678-373-3900
Practice Address - Street 1:1161 HACKNEE CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2771
Practice Address - Country:US
Practice Address - Phone:678-373-3900
Practice Address - Fax:678-373-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty