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General NPI Number Information
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NPI Number | 1043662992
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Entity Type | Organization
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Legal Business Name | BLESSED COMPANION PRIVATE DUTY AND PERSONAL CARE SERVICES
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Dates
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Enumeration Date | 07/04/2016
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Last Update Date | 07/04/2016
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Provider Practice Location Address
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Address Line | 2711B BLUFF VIEW DR
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City | GREENVILLE
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State | NC
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Zip | 27834-7746
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Country | US
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Telephone | 252-558-7031
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Fax |
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Provider Business Mailing Address
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Address Line | 2711B BLUFF VIEW DR
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City | GREENVILLE
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State | NC
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Zip | 27834-7746
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Country | US
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Telephone | 252-558-7031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHAKENDRA JANAE GASKINS
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Credential | AA,CNA,MED TECH
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Telephone | 252-558-7031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 452490
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 452490
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 452490
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License Number State | NC
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