Organization Active NPI

Blissfully Supported LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Charlotte, NC
National Provider Identifier
1255973210
Registry record updated Oct 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
BLISSFULLY SUPPORTED LLC
Practice address
645 Dunbrook LN
Charlotte, NC 28217-3405
Phone
(980) 474-9219
NPI assigned
Oct 11, 2019
Last updated
Oct 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2019

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

Authorized official

Name
Arteeca Eccles
Title
Owner
Phone
(980) 474-9219

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

645 Dunbrook LN
Charlotte, NC 28217-3405

Mailing address

645 Dunbrook LN
Charlotte, NC 28217-3405
Phone (980) 474-9219

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570752000000",
    "number": "1255973210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 DUNBROOK LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282173405",
            "telephone_number": "980-474-9219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 DUNBROOK LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282173405",
            "telephone_number": "980-474-9219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLISSFULLY SUPPORTED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-11",
        "last_updated": "2019-10-11",
        "status": "A",
        "authorized_official_last_name": "ECCLES",
        "authorized_official_first_name": "ARTEECA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "980-474-9219"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2019; 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.