Provider Demographics
NPI:1588031140
Name:BLISSTEQ INC
Entity Type:Organization
Organization Name:BLISSTEQ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:CHWEYA
Authorized Official - Last Name:NYAKUNDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-290-2422
Mailing Address - Street 1:1904 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-4339
Mailing Address - Country:US
Mailing Address - Phone:214-290-2422
Mailing Address - Fax:
Practice Address - Street 1:6565 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2490
Practice Address - Country:US
Practice Address - Phone:214-290-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-29
Last Update Date:2015-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility