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General NPI Number Information
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NPI Number | 1275342677
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Entity Type | Organization
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Legal Business Name | BLESSFUL LAKE SENIOR CARE LLC
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 14460 HURRICANE LN
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City | HELENDALE
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State | CA
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Zip | 92342-7793
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Country | US
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Telephone | 760-985-1583
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Fax |
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Provider Business Mailing Address
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Address Line | 16082 WATO RD
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City | APPLE VALLEY
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State | CA
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Zip | 92307-7810
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Country | US
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Telephone | 760-985-1583
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. ELLIS RAY JONES
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Credential |
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Telephone | 760-985-1583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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