Healthcare Provider Details

I. General information

NPI: 1144073941
Provider Name (Legal Business Name): BLIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 NEVIS DR
COLUMBUS OH
43235-5743
US

IV. Provider business mailing address

242 CARROWMOORE DR
PICKERINGTON OH
43147-3511
US

V. Phone/Fax

Practice location:
  • Phone: 515-380-5393
  • Fax:
Mailing address:
  • Phone: 614-338-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JEAN B BAGAZA
Title or Position: CEO
Credential: GROUP HOME
Phone: 515-380-5393