Provider Demographics
NPI:1881437119
Name:FATHER BLESS MY CLINIC LLC
Entity type:Organization
Organization Name:FATHER BLESS MY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:IGBONAGWAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMP
Authorized Official - Phone:678-698-8120
Mailing Address - Street 1:1300 RIDENOUR BLVD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4501
Mailing Address - Country:US
Mailing Address - Phone:678-368-7560
Mailing Address - Fax:
Practice Address - Street 1:1300 RIDENOUR BLVD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4501
Practice Address - Country:US
Practice Address - Phone:770-430-1708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty