Healthcare Provider Details

I. General information

NPI: 1053731620
Provider Name (Legal Business Name): A BLESSED BEGINNING IHS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 N LINDBERGH BLVD STE 60
HAZELWOOD MO
63042-2019
US

IV. Provider business mailing address

7220 N LINDBERGH BLVD STE 60
HAZELWOOD MO
63042-2019
US

V. Phone/Fax

Practice location:
  • Phone: 314-536-4473
  • Fax:
Mailing address:
  • Phone: 314-536-4473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRANDON JIMMERSON
Title or Position: OWNER
Credential:
Phone: 314-536-4473