Healthcare Provider Details

I. General information

NPI: 1659291201
Provider Name (Legal Business Name): BLISSFUL ASSISTED LIVING 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 S RALEIGH ST
DENVER CO
80219-5152
US

IV. Provider business mailing address

1999 S RALEIGH ST
DENVER CO
80219-5152
US

V. Phone/Fax

Practice location:
  • Phone: 440-494-3285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: TSIGIE GEBREEGZIABHER
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 440-494-3285