Healthcare Provider Details

I. General information

NPI: 1588031140
Provider Name (Legal Business Name): BLISSTEQ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2015
Last Update Date: 08/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N MACARTHUR BLVD SUITE 225
IRVING TX
75039-2490
US

IV. Provider business mailing address

1904 BROOKVIEW DR
ARLINGTON TX
76010-4339
US

V. Phone/Fax

Practice location:
  • Phone: 214-290-2422
  • Fax:
Mailing address:
  • Phone: 214-290-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: GEORGE CHWEYA NYAKUNDI
Title or Position: PRESIDENT
Credential:
Phone: 214-290-2422