Provider Demographics
NPI:1467228932
Name:BLISSFUL REJUVENATION, INC.
Entity Type:Organization
Organization Name:BLISSFUL REJUVENATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DIANE GUNTER
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:863-444-8511
Mailing Address - Street 1:216 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-3904
Mailing Address - Country:US
Mailing Address - Phone:863-491-1020
Mailing Address - Fax:863-491-1440
Practice Address - Street 1:216 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-3904
Practice Address - Country:US
Practice Address - Phone:863-491-1020
Practice Address - Fax:863-491-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care