Provider Demographics
NPI:1598462830
Name:BLESSING SSUBI LLC
Entity Type:Organization
Organization Name:BLESSING SSUBI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMUGAMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-942-4603
Mailing Address - Street 1:5410 QUAKERTOWN AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2523
Mailing Address - Country:US
Mailing Address - Phone:818-942-4603
Mailing Address - Fax:
Practice Address - Street 1:12429 W MIDWAY AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-1833
Practice Address - Country:US
Practice Address - Phone:818-942-4603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health