Provider Demographics
NPI:1679280325
Name:A BLESSED HOME LLC
Entity type:Organization
Organization Name:A BLESSED HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALLEN
Authorized Official - Middle Name:MERCADO
Authorized Official - Last Name:AZUCENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-683-9883
Mailing Address - Street 1:309 LA RUE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-4170
Mailing Address - Country:US
Mailing Address - Phone:702-683-9883
Mailing Address - Fax:702-333-1124
Practice Address - Street 1:309 LA RUE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4170
Practice Address - Country:US
Practice Address - Phone:702-683-9883
Practice Address - Fax:702-333-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home