Provider Demographics
NPI:1558170324
Name:A PLACE OF BLISS LLC
Entity type:Organization
Organization Name:A PLACE OF BLISS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:IKISEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-283-8728
Mailing Address - Street 1:10440 GRASS VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4549
Mailing Address - Country:US
Mailing Address - Phone:209-283-8728
Mailing Address - Fax:
Practice Address - Street 1:10440 GRASS VALLEY CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4549
Practice Address - Country:US
Practice Address - Phone:209-283-8728
Practice Address - Fax:209-259-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility