Provider Demographics
NPI:1992006555
Name:HOUSE OF BLESSING AFCH
Entity Type:Organization
Organization Name:HOUSE OF BLESSING AFCH
Other - Org Name:HANSON, MARTHA AFCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-217-8667
Mailing Address - Street 1:851 NANDINA DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327
Mailing Address - Country:US
Mailing Address - Phone:954-217-8667
Mailing Address - Fax:954-385-1547
Practice Address - Street 1:851 NANDINA DRIVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327
Practice Address - Country:US
Practice Address - Phone:954-217-8667
Practice Address - Fax:954-385-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6905590372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty