Blissful Jackson Facility LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BLISSFUL JACKSON FACILITY LLC

Practice address

4105 Jackson St
Riverside, CA 92503-3911

Phone

(310) 729-3844

NPI assigned

Nov 6, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ken Clavio

Title

Ceo

Phone

(310) 729-3844

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731110400000",
    "number": "1164245304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4105 JACKSON ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033911",
            "telephone_number": "310-729-3844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 JACKSON ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033911",
            "telephone_number": "310-729-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLISSFUL JACKSON FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-06",
        "last_updated": "2024-11-09",
        "certification_date": "2024-11-09",
        "status": "A",
        "authorized_official_last_name": "CLAVIO",
        "authorized_official_first_name": "KEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-729-3844"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Blincoe Jr.
• Judith Christine Blinkinsop, P.A-C
• Christopher T Bliss
• Blissful Canyon Home Care II
• Blissful Canyon Home Care LLC
• Clarisa Marie Bloemhof
• Katelynn Christine Bloom
• Lakemie Catricia Blount
• Lindsay Joy Blount, COTA/L
• Bluestone Recovery, Inc.

• Assisted Living Facility in Riverside, CA
• Providers in Riverside, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.