Personalized Nursing Light House, Inc.

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

821032 Issued in MI

Legal business name

PERSONALIZED NURSING LIGHT HOUSE, INC.

Practice address

575 S Main St Ste 6
Plymouth, MI 48170-1778

Phone

(734) 451-7800

Fax

(734) 451-5410

NPI assigned

Mar 9, 2007

Last updated

May 7, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joseph S Paliwoda, MBA, CAC-I

Title

Ceo

Phone

(734) 451-7800

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525651200000",
    "number": "1639201262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 S MAIN ST",
            "address_2": "SUITE 6",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701778",
            "telephone_number": "734-451-7800",
            "fax_number": "734-451-5410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 S MAIN ST STE 6",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701778",
            "telephone_number": "734-451-7800",
            "fax_number": "734-451-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZED NURSING LIGHT HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2018-05-07",
        "status": "A",
        "authorized_official_last_name": "PALIWODA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "734-451-7800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA, CAC-I"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MI",
            "license": "821032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.