Provider Demographics
NPI:1265298475
Name:MY BLESSED HOME
Entity type:Organization
Organization Name:MY BLESSED HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:816-878-1248
Mailing Address - Street 1:300 SW NOEL ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-3810
Mailing Address - Country:US
Mailing Address - Phone:816-678-8061
Mailing Address - Fax:
Practice Address - Street 1:307 E 63RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2225
Practice Address - Country:US
Practice Address - Phone:816-678-8061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility