Healthcare Provider Details

I. General information

NPI: 1003533019
Provider Name (Legal Business Name): BLISSFUL HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 05/19/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BROADSTONE WAY STE 103
APEX NC
27502-5013
US

IV. Provider business mailing address

4001 COLD HARBOUR DR
RALEIGH NC
27610-6245
US

V. Phone/Fax

Practice location:
  • Phone: 919-578-1994
  • Fax:
Mailing address:
  • Phone: 919-623-9096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMEKA M ROUNDTREE
Title or Position: OWNER
Credential:
Phone: 919-623-9096