=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295298602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLESSING SENIOR CARE SPECIALISTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2019
-----------------------------------------------------
Last Update Date | 04/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2809 REGAL RD STE 101
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75075-6309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-423-0220
-----------------------------------------------------
Fax | 972-423-0233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3806 MARCHWOOD DR
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75082-3635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-423-0220
-----------------------------------------------------
Fax | 972-423-0233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. LORIE ANN BELITERE-BLESSING
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 972-423-0220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------