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General NPI Number Information
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NPI Number | 1184398331
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Entity Type | Organization
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Legal Business Name | REVIVAL RECOVERY CENTER STAFFING LLC
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 208 W HIGHLAND RD STE 102
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City | HIGHLAND
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State | MI
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Zip | 48357-4574
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Country | US
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Telephone | 833-773-8482
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Fax | 810-775-0303
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Provider Business Mailing Address
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Address Line | 208 W HIGHLAND RD STE 102
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City | HIGHLAND
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State | MI
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Zip | 48357-4574
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Country | US
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Telephone | 833-773-8482
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Fax | 810-775-0303
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Authorized Official
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Title or Position | OWNER, AUTHORIZED OFFICIAL
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Name | LISA A PERNA
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Credential | FNP
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Telephone | 248-949-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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