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BLISSFUL JACKSON FACILITY LLC
NPI 1164245304
Assisted Living Facility in Riverside, CA

Active since November 06, 2024
4105 JACKSON ST, RIVERSIDE, CA 92503(310) 729-3844 Get Directions Write a Review

NPPES record last updated: November 9, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Table of Contents

  1. NPI Profile Information
  2. Primary Taxonomy
  3. Authorized Official
  4. Frequently Asked Questions
  • Organization
  • Assisted Living Facility

About BLISSFUL JACKSON FACILITY LLC

This page provides the complete NPI Profile along with additional information for Blissful Jackson Facility Llc, a provider established in Riverside, California operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1164245304 assigned on November 2024. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The authorized official of this NPI record is Ken Clavio (Ceo)

NPI
1164245304 Verify this NPI
Provider Name
BLISSFUL JACKSON FACILITY LLC
Entity Type
Organization
Location Address
4105 JACKSON ST RIVERSIDE, CA 92503
Location Phone
(310) 729-3844
Mailing Address
4105 JACKSON ST RIVERSIDE, CA 92503
Mailing Phone
(310) 729-3844
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
11-06-2024
Last Update Date
11-09-2024
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Assisted Living Facility

Taxonomy Code
310400000X
Type
Nursing & Custodial Care Facilities
Taxonomy Description
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

KEN CLAVIO

Authorized Official Title
CEO
Authorized Official Phone
(310) 729-3844

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Frequently Asked Questions

What is BLISSFUL JACKSON FACILITY LLC's NPI number?

The NPI number assigned to this healthcare provider is 1164245304, enumerated as an "organization" on November 06, 2024.

Where is the provider located?

The provider is located at 4105 JACKSON ST RIVERSIDE, CA 92503 and the phone number is (310) 729-3844.

What is the provider's specialty?

Assisted Living Facility with taxonomy code 310400000X.