Provider Demographics
NPI:1629518402
Name:BLISS HEART CARE COORDINATION
Entity Type:Organization
Organization Name:BLISS HEART CARE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-885-7055
Mailing Address - Street 1:1950 TERREBONNE LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-7274
Mailing Address - Country:US
Mailing Address - Phone:907-885-7055
Mailing Address - Fax:
Practice Address - Street 1:1950 TERREBONNE LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-7274
Practice Address - Country:US
Practice Address - Phone:907-885-7055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1048145171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty