Healthcare Provider Details

I. General information

NPI: 1639956972
Provider Name (Legal Business Name): NEW VISION WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44777 SALTZ RD
CANTON MI
48187-2982
US

IV. Provider business mailing address

44777 SALTZ RD
CANTON MI
48187-2982
US

V. Phone/Fax

Practice location:
  • Phone: 313-529-1267
  • Fax:
Mailing address:
  • Phone: 313-529-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. HONORINE N NJITA
Title or Position: ADMINISTRATOR
Credential: DNP,FNP-BC
Phone: 313-529-1267