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NPI Code Detail

MEDICARE: BLISSFULLY SUPPORTED ENTERPRISES INC

MEDICARE: BLISSFULLY SUPPORTED ENTERPRISES INC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2251B00000XCase Management Agency
3251E00000XHome Health Agency
4310400000XAssisted Living Facility
5332B00000XDurable Medical Equipment & Medical Supplies
6251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1942027628
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLISSFULLY SUPPORTED ENTERPRISES INC
Provider Business Mailing Address
First Line : 714 MONTANA DR STE J
Second Line :
City : CHARLOTTE
State : NC
Zip : 28216-0076
Country : US
Telephone Number : 704-526-6407
Fax Number :
Provider Business Practice Location Address
First Line : 714 MONTANA DR STE J
Second Line :
City : CHARLOTTE
State : NC
Zip : 28216-0076
Country : US
Telephone Number : 704-526-6407
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KADEJIA MUNGO
Credential :
Telephone Number : 704-526-6407
Provider Enumeration Date : 09/24/2024
Last Update Date : 09/24/2024

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