MEDICARE: NEW LIGHT SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1245026145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIGHT SERVICES INC

Provider Business Mailing Address
First Line	:	8075 EDEN PRAIRIE RD APT 245
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-3303
Country	:	US
Telephone Number	:	424-313-4938
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 15TH AVE S
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-5688
Country	:	US
Telephone Number	:	424-313-4938
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. KHALID MOHAMUD
Credential	:
Telephone Number	:	424-313-4938

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	04/17/2025

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Directions to “NEW LIGHT SERVICES INC ” Practice Location

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