Healthcare Provider Details

I. General information

NPI: 1386509966
Provider Name (Legal Business Name): NEW LIGHT HEALTHCARE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 BLENDON GROVE WAY
COLUMBUS OH
43230-9857
US

IV. Provider business mailing address

4013 BLENDON GROVE WAY
COLUMBUS OH
43230-9857
US

V. Phone/Fax

Practice location:
  • Phone: 614-806-6755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LIBAN MOHAMED
Title or Position: OWNER
Credential:
Phone: 614-806-6755