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NPI Code Detail

MEDICARE: NEW LIGHT RECOVERY CENTER, INC.

MEDICARE: NEW LIGHT RECOVERY CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center821624MI

General Provider Information

NPI Number : 1801910674
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW LIGHT RECOVERY CENTER, INC.
Provider Business Mailing Address
First Line : 35874 CONGRESS RD
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48335-1224
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 W MCNICHOLS RD
Second Line :
City : DETROIT
State : MI
Zip : 48203-2703
Country : US
Telephone Number : 313-867-8015
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. SERGE JEAN-LOUIS
Credential : M.D
Telephone Number : 313-867-8015
Provider Enumeration Date : 03/19/2007
Last Update Date : 08/22/2020

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