Healthcare Provider Details

I. General information

NPI: 1275178949
Provider Name (Legal Business Name): BLESSED GROUP HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2019
Last Update Date: 11/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 MANTLEPIECE CT
BURKE VA
22015-3239
US

IV. Provider business mailing address

6101 MANTLEPIECE CT
BURKE VA
22015-3239
US

V. Phone/Fax

Practice location:
  • Phone: 703-239-2069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BLESS KETUM
Title or Position: CEO
Credential:
Phone: 240-505-9449