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General NPI Number Information
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NPI Number | 1265298475
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Entity Type | Organization
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Legal Business Name | MY BLESSED HOME
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 307 E 63RD ST
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City | KANSAS CITY
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State | MO
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Zip | 64113-2225
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Country | US
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Telephone | 816-678-8061
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Fax |
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Provider Business Mailing Address
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Address Line | 300 SW NOEL ST
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City | LEES SUMMIT
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State | MO
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Zip | 64063-3810
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Country | US
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Telephone | 816-678-8061
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAMON HARRELL JR.
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Credential |
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Telephone | 816-878-1248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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