Provider Demographics
NPI:1912480344
Name:BEAUTIFUL BLESSINGS SUPPORT COORDINATION AGENCY
Entity Type:Organization
Organization Name:BEAUTIFUL BLESSINGS SUPPORT COORDINATION AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:NICOLES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-650-3232
Mailing Address - Street 1:5905 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3525
Mailing Address - Country:US
Mailing Address - Phone:215-650-3232
Mailing Address - Fax:
Practice Address - Street 1:5905 NASSAU RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3525
Practice Address - Country:US
Practice Address - Phone:215-650-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management