Provider Demographics
NPI:1851781124
Name:BLESSED ASSURANCE NURSING AND IN HOME SERVICES INC.
Entity Type:Organization
Organization Name:BLESSED ASSURANCE NURSING AND IN HOME SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYLVANUS
Authorized Official - Middle Name:AMANZE
Authorized Official - Last Name:ANUFORO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-717-7014
Mailing Address - Street 1:3329 FRANKLIN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-2108
Mailing Address - Country:US
Mailing Address - Phone:404-717-7014
Mailing Address - Fax:770-577-3162
Practice Address - Street 1:3329 FRANKLIN FOREST DR
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:GA
Practice Address - Zip Code:30187-2108
Practice Address - Country:US
Practice Address - Phone:404-717-7014
Practice Address - Fax:770-577-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048R1053253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151263AMedicaid
GA003151265AMedicaid