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General NPI Number Information
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NPI Number | 1134837073
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Entity Type | Organization
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Legal Business Name | B&G BLESSED HOMES LLC
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 13885 HEDGEWOOD DR STE 317
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City | WOODBRIDGE
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State | VA
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Zip | 22193-7932
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Country | US
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Telephone | 571-343-9117
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Fax |
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Provider Business Mailing Address
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Address Line | 7527 MINT SPRINGS CT
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City | MANASSAS
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State | VA
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Zip | 20109-5712
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Country | US
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Telephone | 571-343-9117
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MAAME GYASIWAH OSEI BRANTUO
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Credential | RN
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Telephone | 571-343-9117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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