Provider Demographics
NPI:1629829718
Name:GODDESS BLISS LLC
Entity Type:Organization
Organization Name:GODDESS BLISS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-483-6153
Mailing Address - Street 1:17485 N PORTER RD APT I303
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4724
Mailing Address - Country:US
Mailing Address - Phone:520-483-6153
Mailing Address - Fax:
Practice Address - Street 1:2820 S ALMA SCHOOL ROAD
Practice Address - Street 2:STE 18655
Practice Address - City:MARICOPA/AZ
Practice Address - State:AZ
Practice Address - Zip Code:85138
Practice Address - Country:US
Practice Address - Phone:520-483-6153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty