Provider Demographics
NPI:1396518437
Name:BLISSFUL LIVING HOME LLC
Entity type:Organization
Organization Name:BLISSFUL LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJITPAL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-730-6270
Mailing Address - Street 1:6325 W BRILES RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1003
Mailing Address - Country:US
Mailing Address - Phone:602-730-6270
Mailing Address - Fax:
Practice Address - Street 1:20706 N 74TH LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-9661
Practice Address - Country:US
Practice Address - Phone:602-705-3551
Practice Address - Fax:623-321-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility