Healthcare Provider Details

I. General information

NPI: 1801668793
Provider Name (Legal Business Name): A BLESSED HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LEMAY FERRY RD STE 101
SAINT LOUIS MO
63125-1537
US

IV. Provider business mailing address

3748 S BROADWAY
SAINT LOUIS MO
63118-4029
US

V. Phone/Fax

Practice location:
  • Phone: 314-683-3903
  • Fax:
Mailing address:
  • Phone: 314-683-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KANESHA GRIFFIN
Title or Position: CEO
Credential:
Phone: 314-683-3903