Provider Demographics
NPI:1770770554
Name:BLESSED HEALTH CARE PROVIDER INC
Entity type:Organization
Organization Name:BLESSED HEALTH CARE PROVIDER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-392-8917
Mailing Address - Street 1:1768 ARROW HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-5335
Mailing Address - Country:US
Mailing Address - Phone:626-858-2319
Mailing Address - Fax:626-858-8355
Practice Address - Street 1:1768 ARROW HWY STE 103
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5335
Practice Address - Country:US
Practice Address - Phone:626-858-2319
Practice Address - Fax:626-858-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D1070865OtherCLIA CERT OF WAIVER
05D1070865OtherCLIA CERT OF WAIVER