Healthcare Provider Details

I. General information

NPI: 1942652169
Provider Name (Legal Business Name): BLISSETT HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 LENOX DR
VALDOSTA GA
31605-7433
US

IV. Provider business mailing address

PO BOX 4031
VALDOSTA GA
31604-4031
US

V. Phone/Fax

Practice location:
  • Phone: 229-548-9774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATWANYA MONIQUE BLISSETT
Title or Position: CEO
Credential:
Phone: 229-548-9774