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General NPI Number Information
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NPI Number | 1578223541
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Entity Type | Organization
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Legal Business Name | BLESSED GROUP HOME
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Dates
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Enumeration Date | 12/17/2021
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 20928 SW 118TH CT
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City | MIAMI
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State | FL
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Zip | 33177-7023
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Country | US
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Telephone | 786-314-1267
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Fax |
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Provider Business Mailing Address
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Address Line | 2181 NW 99TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-1416
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Country | US
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Telephone | 786-314-1267
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | LISANDRA HERNANDEZ
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Credential | REGISTER NURSE
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Telephone | 786-314-1267
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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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