Provider Demographics
NPI:1770908386
Name:BLESSED RETIREMENT HOME LLC
Entity type:Organization
Organization Name:BLESSED RETIREMENT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-732-6691
Mailing Address - Street 1:16861 SW 92ND CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4514
Mailing Address - Country:US
Mailing Address - Phone:786-732-6691
Mailing Address - Fax:
Practice Address - Street 1:16861 SW 92ND CT
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4514
Practice Address - Country:US
Practice Address - Phone:786-732-6691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility