Provider Demographics
NPI:1760542286
Name:BLESSED COMMUNITY LIVING CENTER INC
Entity Type:Organization
Organization Name:BLESSED COMMUNITY LIVING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:UGO
Authorized Official - Middle Name:EJIOGU
Authorized Official - Last Name:MAHYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-202-4154
Mailing Address - Street 1:15714 CROOKED ARROW DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-7549
Mailing Address - Country:US
Mailing Address - Phone:832-202-4154
Mailing Address - Fax:281-265-1690
Practice Address - Street 1:15714 CROOKED ARROW DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-7549
Practice Address - Country:US
Practice Address - Phone:832-202-4154
Practice Address - Fax:281-265-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty