PERSONALIZED NURSING LIGHT HOUSE, INC. (NPI# 1639201262) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639201262 |
| Entity Type | Organization |
| Organization Name | PERSONALIZED NURSING LIGHT HOUSE, INC. |
| Practice Address |
575 S Main St Ste 6 Plymouth MI 48170-1778 |
| Mailing Address |
575 S Main St Suite 6 Plymouth MI 48170-1778 |
| Practice Telephone | 7344517800 |
| Practice Fax Number | 7344515410 |
| Mailing Telephone | 7344517800 |
| Mailing Fax Number | 7344515410 |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2018-05-07 |
| Authorized Official Name | MR. JOSEPH S PALIWODA (CEO) |
| Authorized Official Telephone | 7344517800 |
| Authorized Official Credential | MBA, CAC-I |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
821032 | MI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | STATE LICENSE | 821032 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942522818 | Personalized Nursing Light House, Inc. | Substance Abuse Rehabilitation Facility | 7430 North Inkster Road, Dearborn Heights, MI 48127 | 2010-02-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PERSONALIZED NURSING LIGHT HOUSE, INC. | 575 S Main St Ste 6, Plymouth, MI 48170-1778 |
| Street Address |
575 S MAIN ST STE 6 |
| City | PLYMOUTH |
| State | MI |
| Zip Code | 48170-1778 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275147126 | Gerald Glass | Social Worker | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2020-09-08 |
| 1871118141 | Shiara Camille Mupas | Social Worker | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2020-06-12 |
| 1689217408 | Tegan Marie Gadette | Counselor | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2019-10-24 |
| 1932758430 | Leon Devone Barber Jr. | Counselor | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2019-09-06 |
| 1063070720 | Roy Helton | Psychologist | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2019-05-29 |
| 1548826449 | Samantha Kempf | Counselor | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2019-05-15 |
| 1740744648 | Kyle Douglas Neely | Social Worker | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2019-01-24 |
| 1871000224 | Jaymin Cox | Counselor | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2018-01-08 |
| 1841707536 | Gregory Douglas | Counselor | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2018-01-04 |
| 1326578659 | Clare Waterstradt | Counselor | 575 S Main St Ste 6, Plymouth, MI 48170-1778 | 2017-06-19 |
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| 1003470964 | Smiley Private Homecare LLC | Technician, Pathology | 1098 Ann Arbor Rd #249, Plymouth, MI 48170 | 2019-04-26 |
| 1275003832 | Atsalis Dental Excellence | Dentist | 690 South Main St, Plymouth, MI 48170 | 2018-11-27 |
| 1275003808 | Danielle Cefalo | Speech-Language Pathologist | 801 W. Ann Arbor Trail Suite 220, Plymouth, MI 48170 | 2018-11-27 |
| 1962987966 | Mindful Wellness Counseling, LLC | Social Worker | 9266 Northern Ave, Plymouth, MI 48170 | 2018-09-26 |
| 1972094027 | Plymouth Urgent Care Walk-in Clinic LLC | Clinic/Center | 1498 S Sheldon Rd, Plymouth, MI 48170 | 2018-05-24 |
| 1356843791 | Polaris Pharmacy Services of Michigan, LLC | Pharmacy | 9131 General Court, Plymouth, MI 48170 | 2018-03-01 |
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| 1073029484 | Holly Ann Haase | Technician/Technologist | 650 Church St, Plymouth, MI 48170 | 2017-12-20 |
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| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| 1679714083 | Great Lakes Recovery Centers, Inc. | Clinic/Center | 1401 N. 26th Street, Suite 109, Escanaba, MI 49801 | 2009-03-13 |
| 1962606632 | St Johns Home | Clinic/Center | 2355 Knapp St Ne, Grand Rapids, MI 49505-4415 | 2007-06-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.