Provider Demographics
NPI:1831755958
Name:BLESSED SUPPORT PROFESSIONALS, INC
Entity type:Organization
Organization Name:BLESSED SUPPORT PROFESSIONALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:BANAHENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-926-9739
Mailing Address - Street 1:14511 JEFFERSON DAVIS HWY # A
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14511 JEFFERSON DAVIS HWY # A
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2807
Practice Address - Country:US
Practice Address - Phone:703-494-6014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities