MEDICARE: BLISSTEQ 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
1	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1588031140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLISSTEQ INC

Provider Business Mailing Address
First Line	:	1904 BROOKVIEW DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-4339
Country	:	US
Telephone Number	:	214-290-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	6565 N MACARTHUR BLVD
Second Line	:	SUITE 225
City	:	IRVING
State	:	TX
Zip	:	75039-2490
Country	:	US
Telephone Number	:	214-290-2422
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GEORGE CHWEYA NYAKUNDI
Credential	:
Telephone Number	:	214-290-2422

Provider Enumeration Date	:	08/29/2015
Last Update Date	:	08/29/2015

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Directions to “BLISSTEQ INC ” Practice Location

Language	Start Address	Practice Location

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