Healthcare Provider Details

I. General information

NPI: 1710377031
Provider Name (Legal Business Name): BLESSED ASSURANCE NURSING AND IN HOME SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2015
Last Update Date: 01/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3329 FRANKLIN FOREST DR
WINSTON GA
30187-2108
US

IV. Provider business mailing address

3329 FRANKLIN FOREST DR
WINSTON GA
30187-2108
US

V. Phone/Fax

Practice location:
  • Phone: 404-717-7014
  • Fax: 770-577-3162
Mailing address:
  • Phone: 404-717-7014
  • Fax: 770-577-3162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number048R1053
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number048R1053
License Number StateGA

VIII. Authorized Official

Name: SYLVANUS AMANZE ANUFORO
Title or Position: CEO
Credential: RN
Phone: 404-717-7014