Provider Demographics
NPI:1982372892
Name:BLISSFUL RESIDENTIAL HOME INC
Entity Type:Organization
Organization Name:BLISSFUL RESIDENTIAL HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:MAMBO
Authorized Official - Last Name:ASANJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-770-5677
Mailing Address - Street 1:1900 ASCOT PKWY APT 323
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8333
Mailing Address - Country:US
Mailing Address - Phone:650-770-5677
Mailing Address - Fax:
Practice Address - Street 1:1900 ASCOT PKWY APT 323
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8333
Practice Address - Country:US
Practice Address - Phone:650-770-5677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility