Provider Demographics
NPI:1124473814
Name:BODY BLISS LLC
Entity type:Organization
Organization Name:BODY BLISS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NCMT, CST
Authorized Official - Phone:734-224-0621
Mailing Address - Street 1:7355 LEWIS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1465
Mailing Address - Country:US
Mailing Address - Phone:734-224-0621
Mailing Address - Fax:
Practice Address - Street 1:7355 LEWIS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1465
Practice Address - Country:US
Practice Address - Phone:734-224-0621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004627172V00000X
MI7501000854172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty