Healthcare Provider Details

I. General information

NPI: 1316410681
Provider Name (Legal Business Name): THE LIGHT TREATMENT & REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 KREGER ST
STERLING HEIGHTS MI
48310-5728
US

IV. Provider business mailing address

6269 POTOMAC CIR
WEST BLOOMFIELD MI
48322-2125
US

V. Phone/Fax

Practice location:
  • Phone: 248-495-8985
  • Fax:
Mailing address:
  • Phone: 248-495-8985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KARICIA R CARTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-495-8985