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General NPI Number Information
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NPI Number | 1477839082
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Entity Type | Organization
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Legal Business Name | BLESSED & FAVORED ASSISTED LIVING INC.
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 1807 LOST CROSSING TRL
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City | ARLINGTON
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State | TX
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Zip | 76002-3637
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Country | US
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Telephone | 817-500-8496
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Fax |
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Provider Business Mailing Address
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Address Line | 901 COURY RD APT#19
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City | EVERMAN
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State | TX
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Zip | 76140-4355
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Country | US
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Telephone | 817-500-8496
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRANDY KUTRACE MOORE
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Credential |
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Telephone | 817-500-8496
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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 | SSN/ITIN/EIN
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License Number State | TX
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