Healthcare Provider Details

I. General information

NPI: 1689941643
Provider Name (Legal Business Name): BLESSED BEGINNINGS HSC COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 BLUE SMOKE CT N
FORT WORTH TX
76105-1003
US

IV. Provider business mailing address

2320 BLUE SMOKE CT N
FORT WORTH TX
76105-1003
US

V. Phone/Fax

Practice location:
  • Phone: 817-534-5480
  • Fax: 817-534-4748
Mailing address:
  • Phone: 817-534-5480
  • Fax: 817-534-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number32038304195
License Number StateTX

VIII. Authorized Official

Name: DONALD BENJAMIN
Title or Position: CEO
Credential:
Phone: 817-534-5480