Healthcare Provider Details

I. General information

NPI: 1457148751
Provider Name (Legal Business Name): BLISSFUL LIVING ASSISTANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11432 TIVOLI LN APT B
SAINT LOUIS MO
63146-3567
US

IV. Provider business mailing address

11432 TIVOLI LN APT B
SAINT LOUIS MO
63146-3567
US

V. Phone/Fax

Practice location:
  • Phone: 870-768-5157
  • Fax:
Mailing address:
  • Phone: 870-768-5157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY ALLISON
Title or Position: OWNER
Credential:
Phone: 870-768-5157