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

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

Other identifiers 1

Locations

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "821032",
            "state": "MI"
        }
    ],
    "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.