MEDICARE: NEW LIGHT HEALTHCARE SERVICE

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1386509966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIGHT HEALTHCARE SERVICE

Provider Business Mailing Address
First Line	:	4013 BLENDON GROVE WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-9857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4013 BLENDON GROVE WAY
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-9857
Country	:	US
Telephone Number	:	614-806-6755
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LIBAN MOHAMED
Credential	:
Telephone Number	:	614-806-6755

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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Directions to “NEW LIGHT HEALTHCARE SERVICE ” Practice Location

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