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NPI Code Detail

MEDICARE: BLESSED HOME AFC SERVICES, LLC

MEDICARE: BLESSED HOME AFC SERVICES, 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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityAL 110238445MI

General Provider Information

NPI Number : 1346689221
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLESSED HOME AFC SERVICES, LLC
Provider Business Mailing Address
First Line : 1217 STATELINE RD
Second Line :
City : NILES
State : MI
Zip : 49120-4729
Country : US
Telephone Number : 269-684-2668
Fax Number : 269-683-8986
Provider Business Practice Location Address
First Line : 1217 STATELINE RD
Second Line :
City : NILES
State : MI
Zip : 49120-4729
Country : US
Telephone Number : 269-684-2668
Fax Number : 269-683-8986
Authorized Official
Title or Position : ADMINISTRATOR
Name : MICHAEL ADENIYI
Credential : PHD, ND
Telephone Number : 269-684-2668
Provider Enumeration Date : 06/24/2013
Last Update Date : 06/24/2013

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Directions to “BLESSED HOME AFC SERVICES, LLC ” Practice Location

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