Provider Demographics
NPI:1093133720
Name:PERPETUAL BLISS MIHP LLC
Entity Type:Organization
Organization Name:PERPETUAL BLISS MIHP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA DIANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:REBOYA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:248-722-4860
Mailing Address - Street 1:28720 BAYBERRY CT W
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25321 5 MILE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3700
Practice Address - Country:US
Practice Address - Phone:248-722-4860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIE39986251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare