Healthcare Provider Details

I. General information

NPI: 1992006555
Provider Name (Legal Business Name): HOUSE OF BLESSING AFCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 NANDINA DRIVE
WESTON FL
33327
US

IV. Provider business mailing address

851 NANDINA DRIVE
WESTON FL
33327
US

V. Phone/Fax

Practice location:
  • Phone: 954-217-8667
  • Fax: 954-385-1547
Mailing address:
  • Phone: 954-217-8667
  • Fax: 954-385-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number6905590
License Number StateFL

VIII. Authorized Official

Name: MARTHA HANSON
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 954-217-8667