MEDICARE: BLISSFUL LIVING HOME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1396518437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLISSFUL LIVING HOME LLC

Provider Business Mailing Address
First Line	:	6325 W BRILES RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-1003
Country	:	US
Telephone Number	:	602-730-6270
Fax Number	:

Provider Business Practice Location Address
First Line	:	20706 N 74TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-9661
Country	:	US
Telephone Number	:	602-705-3551
Fax Number	:	623-321-1240

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AJITPAL SINGH MANN
Credential	:
Telephone Number	:	602-730-6270

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	10/31/2023

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Directions to “BLISSFUL LIVING HOME LLC ” Practice Location

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