Provider Demographics
NPI:1609458991
Name:BLISS@HOME LLC
Entity Type:Organization
Organization Name:BLISS@HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAKEELAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIFOWOSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-968-2125
Mailing Address - Street 1:7422 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082
Mailing Address - Country:US
Mailing Address - Phone:347-968-2125
Mailing Address - Fax:
Practice Address - Street 1:7422 MILLER AVE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082
Practice Address - Country:US
Practice Address - Phone:347-968-2125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care