Healthcare Provider Details

I. General information

NPI: 1477839082
Provider Name (Legal Business Name): BLESSED & FAVORED ASSISTED LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 LOST CROSSING TRL
ARLINGTON TX
76002-3637
US

IV. Provider business mailing address

901 COURY RD APT#19
EVERMAN TX
76140-4355
US

V. Phone/Fax

Practice location:
  • Phone: 817-500-8496
  • Fax:
Mailing address:
  • Phone: 817-500-8496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberSSN/ITIN/EIN
License Number StateTX

VIII. Authorized Official

Name: BRANDY KUTRACE MOORE
Title or Position: PRESIDENT
Credential:
Phone: 817-500-8496