Provider Demographics
NPI:1215262936
Name:BLESSED HEALTHCARE AND STAFFING AGENCY
Entity type:Organization
Organization Name:BLESSED HEALTHCARE AND STAFFING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERTISSHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODS-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-390-8646
Mailing Address - Street 1:99 W HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4014
Mailing Address - Country:US
Mailing Address - Phone:631-390-8646
Mailing Address - Fax:631-390-8645
Practice Address - Street 1:99 W HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4014
Practice Address - Country:US
Practice Address - Phone:631-390-8646
Practice Address - Fax:631-390-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1621L001251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1215262936Medicaid