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NPI Code Detail

MEDICARE: BLISSFUL LIVING GROUP HOME, INC.

MEDICARE: BLISSFUL LIVING GROUP HOME, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number : 1427723295
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLISSFUL LIVING GROUP HOME, INC.
Provider Business Mailing Address
First Line : 400 N MOUNTAIN AVE
Second Line :
City : UPLAND
State : CA
Zip : 91786-5176
Country : US
Telephone Number : 909-303-3314
Fax Number : 909-303-3315
Provider Business Practice Location Address
First Line : 1206 W 14TH ST
Second Line :
City : UPLAND
State : CA
Zip : 91786-2517
Country : US
Telephone Number : 909-360-8526
Fax Number :
Authorized Official
Title or Position : CEO/ADMINISTRATOR
Name : MRS. FELICIA ALEXANDER
Credential :
Telephone Number : 909-303-3314
Provider Enumeration Date : 08/12/2021
Last Update Date : 08/12/2021

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Directions to “BLISSFUL LIVING GROUP HOME, INC. ” Practice Location

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