Provider Demographics
NPI:1790925915
Name:BLESSINGS ASSURANCE PERSONAL CARE HOME
Entity Type:Organization
Organization Name:BLESSINGS ASSURANCE PERSONAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:RENNA
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-469-3977
Mailing Address - Street 1:285 VICKERY LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-4680
Mailing Address - Country:US
Mailing Address - Phone:678-469-3977
Mailing Address - Fax:770-755-1397
Practice Address - Street 1:285 VICKERY LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-4680
Practice Address - Country:US
Practice Address - Phone:678-469-3977
Practice Address - Fax:770-755-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA485403553AMedicaid