Provider Demographics
NPI:1801035720
Name:BOUNTIFUL BLESSINGS LLC
Entity Type:Organization
Organization Name:BOUNTIFUL BLESSINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-927-9330
Mailing Address - Street 1:2156 WOODDALE BLVD
Mailing Address - Street 2:STE 140A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1403
Mailing Address - Country:US
Mailing Address - Phone:225-927-9330
Mailing Address - Fax:225-927-9331
Practice Address - Street 1:2156 WOODDALE BLVD
Practice Address - Street 2:STE 140A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1403
Practice Address - Country:US
Practice Address - Phone:225-927-9330
Practice Address - Fax:225-927-9331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA 15175251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care