Provider Demographics
NPI:1649720673
Name:BLISSFUL LLC
Entity type:Organization
Organization Name:BLISSFUL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-998-2729
Mailing Address - Street 1:760 OLD ROSWELL RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2279
Mailing Address - Country:US
Mailing Address - Phone:404-998-2729
Mailing Address - Fax:404-745-8150
Practice Address - Street 1:760 OLD ROSWELL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2279
Practice Address - Country:US
Practice Address - Phone:404-998-2729
Practice Address - Fax:404-745-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-1377251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care