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General NPI Number Information
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NPI Number | 1093110546
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Entity Type | Organization
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Legal Business Name | BLESSED HOMECARE LLC
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 219 EVERGREEN CIR
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2944
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Country | US
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Telephone | 615-456-4013
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Fax |
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Provider Business Mailing Address
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Address Line | 219 EVERGREEN CIR
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2944
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Country | US
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Telephone | 615-456-4013
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR/MANAGER
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Name | CAROL LEATHERMAN
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Credential | CNA
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Telephone | 615-456-4013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 671766
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 0000002538
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 087330800
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 0000002538
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 671766
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License Number State | TN
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