MEDICARE: BLESSED BY BEAUTY HOME HEALTH CARE 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	:	1366922593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLESSED BY BEAUTY HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3111 S CEDAR CREST CT
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64057-1900
Country	:	US
Telephone Number	:	314-339-4452
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 S CEDAR CREST CT
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64057-1900
Country	:	US
Telephone Number	:	816-239-1228
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANTONIO MAC LLOYD
Credential	:
Telephone Number	:	314-339-4452

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	08/16/2018

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