Provider Demographics
NPI:1417432030
Name:BLISSFUL HEALTHCARE LLC
Entity Type:Organization
Organization Name:BLISSFUL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKELEW
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:334-300-4812
Mailing Address - Street 1:101 E PAULK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1727
Mailing Address - Country:US
Mailing Address - Phone:334-493-0311
Mailing Address - Fax:334-493-0355
Practice Address - Street 1:101 E PAULK AVE STE A
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1727
Practice Address - Country:US
Practice Address - Phone:334-493-0311
Practice Address - Fax:334-493-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty