Provider Demographics
NPI:1942027628
Name:BLISSFULLY SUPPORTED ENTERPRISES INC
Entity type:Organization
Organization Name:BLISSFULLY SUPPORTED ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KADEJIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-526-6407
Mailing Address - Street 1:714 MONTANA DR STE J
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0076
Mailing Address - Country:US
Mailing Address - Phone:704-526-6407
Mailing Address - Fax:
Practice Address - Street 1:714 MONTANA DR STE J
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0076
Practice Address - Country:US
Practice Address - Phone:704-526-6407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies