MEDICARE: SIMPLE BLESSINGS CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	PCH008546	GA

General Provider Information

NPI Number	:	1578006631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE BLESSINGS CORP

Provider Business Mailing Address
First Line	:	2231 SULLIVAN RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-4233
Country	:	US
Telephone Number	:	706-869-2083
Fax Number	:	706-496-8677

Provider Business Practice Location Address
First Line	:	2231 SULLIVAN RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-4233
Country	:	US
Telephone Number	:	706-869-2083
Fax Number	:	706-496-8677

Authorized Official
Title or Position	:	OWNER
Name	:	SARAH ELLISON
Credential	:
Telephone Number	:	706-306-6110

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	11/22/2016

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Directions to “SIMPLE BLESSINGS CORP ” Practice Location

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