1972665446 NPI number — BLESSED CARE, INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972665446 NPI number — BLESSED CARE, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLESSED CARE, INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972665446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 2ND AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70601-8922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-480-9757
Provider Business Mailing Address Fax Number:
337-562-1374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 2ND AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-8922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-480-9757
Provider Business Practice Location Address Fax Number:
337-562-1374
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUILLORY
Authorized Official First Name:
HILDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
337-480-9757

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  SIL 6995 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1584444 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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