MEDICARE: TO BE BLESSED HOME HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1043026818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TO BE BLESSED HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	1155 LINCOLN AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40208-1057
Country	:	US
Telephone Number	:	513-709-4672
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 LINCOLN AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40208-1057
Country	:	US
Telephone Number	:	513-709-4672
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAWNTE MOORE
Credential	:
Telephone Number	:	513-709-4672

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	12/06/2024

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