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General NPI Number Information
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NPI Number | 1376428938
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Entity Type | Organization
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Legal Business Name | THE NEON MOVEMENT WELLNESS CENTER LLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 185 E MAIN ST STE 405
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City | BENTON HARBOR
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State | MI
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Zip | 49022-4432
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Country | US
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Telephone | 269-588-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 1388 SAINT THOMAS ST UNIT B
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City | BENTON HARBOR
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State | MI
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Zip | 49022-3908
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Country | US
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Telephone | 269-861-1169
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KIBRA L VAN HORN-WILLIAMS
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Credential | CPT
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Telephone | 269-861-1169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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