Provider Demographics
NPI:1932468022
Name:BLESSING GROUP HOME
Entity Type:Organization
Organization Name:BLESSING GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICO
Authorized Official - Middle Name:
Authorized Official - Last Name:POLINICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-885-0494
Mailing Address - Street 1:9 BOSSI AVE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2001
Mailing Address - Country:US
Mailing Address - Phone:781-885-0494
Mailing Address - Fax:
Practice Address - Street 1:9 BOSSI AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2001
Practice Address - Country:US
Practice Address - Phone:781-885-0494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLESSINGGROUPHOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253J00000X
MAMAP06412385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No253J00000XAgenciesFoster Care Agency