Healthcare Provider Details

I. General information

NPI: 1962890210
Provider Name (Legal Business Name): BLISS RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 NORTH 10TH AVENUE
GREEN ACRES FL
33463
US

IV. Provider business mailing address

5202 NORTH 10TH AVENUE
GREEN ACRES FL
33463
US

V. Phone/Fax

Practice location:
  • Phone: 954-746-8232
  • Fax: 954-746-8231
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA SMITH
Title or Position: BILLING MANAGER
Credential:
Phone: 954-746-8232