Provider Demographics
NPI:1245837061
Name:BLISS HAVEN GROUP LLC
Entity type:Organization
Organization Name:BLISS HAVEN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:S
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-253-5371
Mailing Address - Street 1:1800 CAMDEN RD STE 107-48
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4690
Mailing Address - Country:US
Mailing Address - Phone:704-904-9322
Mailing Address - Fax:
Practice Address - Street 1:2442 SANDHURST CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2738
Practice Address - Country:US
Practice Address - Phone:704-904-9322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health