Provider Demographics
NPI:1841696564
Name:BLISSFULLY BONDED, LLC
Entity type:Organization
Organization Name:BLISSFULLY BONDED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-499-0977
Mailing Address - Street 1:2095 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1632
Mailing Address - Country:US
Mailing Address - Phone:614-499-0977
Mailing Address - Fax:
Practice Address - Street 1:2095 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1632
Practice Address - Country:US
Practice Address - Phone:614-499-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services