Provider Demographics
NPI:1265983498
Name:BLISS RECOVERY CENTER LLC
Entity type:Organization
Organization Name:BLISS RECOVERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JO-ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-347-7212
Mailing Address - Street 1:624 W TROPICAL WAY
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3348
Mailing Address - Country:US
Mailing Address - Phone:954-347-7212
Mailing Address - Fax:
Practice Address - Street 1:3012 E COMMERCIAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-347-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility