New Light Baptist Church Nursing Home, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2152057 Issued in MI

Legal business name

NEW LIGHT BAPTIST CHURCH NURSING HOME, INC.

Practice address

9500 Grand River Ave
Detroit, MI 48204-2132

Phone

(313) 491-7920

Fax

(313) 491-0510

NPI assigned

Aug 25, 2005

Organization subpart

No

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

Authorized official

Name

Mr. George B. Talley

Title

Administrator

Phone

(313) 491-7920

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• New Light Nursing Home, Inc. Other name

Locations

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720071707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 GRAND RIVER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482042132",
            "telephone_number": "313-491-7920",
            "fax_number": "313-491-0510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 GRAND RIVER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482042132",
            "telephone_number": "313-491-7920",
            "fax_number": "313-491-0510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LIGHT BAPTIST CHURCH NURSING HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TALLEY",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "313-491-7920",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "2152057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2152057",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Light Nursing Home, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Skilled Nursing Facility in Detroit, MI
• Providers in Detroit, MI by specialty
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.