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General NPI Number Information
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NPI Number | 1609435072
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Entity Type | Organization
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Legal Business Name | BLISS HAVEN, INC.
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 1304 DURHAM ST
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City | JOHNSTON CITY
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State | IL
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Zip | 62951-2043
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Country | US
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Telephone | 618-952-0277
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 502
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City | MARION
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State | IL
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Zip | 62959-0502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA BITTLE
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Credential |
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Telephone | 618-927-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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