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General NPI Number Information
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NPI Number | 1275178949
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Entity Type | Organization
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Legal Business Name | BLESSED GROUP HOMES INC
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Dates
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Enumeration Date | 11/16/2019
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Last Update Date | 11/16/2019
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Provider Practice Location Address
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Address Line | 6101 MANTLEPIECE CT
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City | BURKE
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State | VA
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Zip | 22015-3239
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Country | US
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Telephone | 703-239-2069
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 MANTLEPIECE CT
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City | BURKE
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State | VA
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Zip | 22015-3239
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BLESS KETUM
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Credential |
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Telephone | 240-505-9449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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