Healthcare Provider Details

I. General information

NPI: 1962123398
Provider Name (Legal Business Name): NEW LUNA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 TIMPSON AVE SE
ALTO MI
49302-9757
US

IV. Provider business mailing address

6630 TIMPSON AVE SE
ALTO MI
49302-9757
US

V. Phone/Fax

Practice location:
  • Phone: 616-916-3470
  • Fax:
Mailing address:
  • Phone: 616-916-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: ELIZABRTH HESS
Title or Position: OWNER
Credential: LMSW
Phone: 616-916-3470