Provider Demographics
NPI:1700692092
Name:OPENBLISS ADULT RESIDENTIAL LLC
Entity type:Organization
Organization Name:OPENBLISS ADULT RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:AKINRINBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-256-1153
Mailing Address - Street 1:11401 ROLLING GREEN PL
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3165
Mailing Address - Country:US
Mailing Address - Phone:301-256-1153
Mailing Address - Fax:
Practice Address - Street 1:11401 ROLLING GREEN PL
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3165
Practice Address - Country:US
Practice Address - Phone:301-256-1153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities