Healthcare Provider Details

I. General information

NPI: 1033770409
Provider Name (Legal Business Name): BLESSED HOME SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N 70TH AVE
HOLLYWOOD FL
33024-7407
US

IV. Provider business mailing address

630 N 70TH AVE
HOLLYWOOD FL
33024-7407
US

V. Phone/Fax

Practice location:
  • Phone: 305-220-8855
  • Fax:
Mailing address:
  • Phone: 305-220-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: NAJIBE N. ILLA-EL DIK
Title or Position: MANAGER
Credential:
Phone: 305-220-8855