Personalized Nursing Light House Inc

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

SA0631403 Issued in MI

Legal business name

PERSONALIZED NURSING LIGHT HOUSE INC

Doing business as

Male Residential

Practice address

30671 Stephenson Hwy
Madison Heights, MI 48071-1635

Phone

(734) 451-7800

Fax

(810) 231-3845

NPI assigned

Jan 30, 2015

Last updated

May 4, 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

Joseph Stanley Paliwoda

Title

Ceo

Phone

(734) 451-7800

Specialties & licenses 2

Addresses

Other names 1

• Male Residential Doing business as

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

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525392000000",
    "number": "1740670512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 625",
            "city": "LAKELAND",
            "state": "MI",
            "postal_code": "481430625",
            "telephone_number": "734-451-7800",
            "fax_number": "810-231-3845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30671 STEPHENSON HWY",
            "city": "MADISON HEIGHTS",
            "state": "MI",
            "postal_code": "480711635",
            "telephone_number": "734-451-7800",
            "fax_number": "810-231-3845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZED NURSING LIGHT HOUSE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-30",
        "last_updated": "2018-05-04",
        "status": "A",
        "authorized_official_last_name": "PALIWODA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "734-451-7800"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MI",
            "license": "SA0823220",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MI",
            "license": "SA0631403",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Male Residential",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Male Residential",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittain Patton
• Mariuana Paynes, MS, LLP
• Gina Elizabeth Pearson, APRN, ANP-BC
• Samantha Kaur Sidhu Perdeep Singh Sidhu
• Sherria E Perry, CCHW
• Jerek Bradford Petrous, D.D.S., M.S.
• Kristofer Antonio Picano
• Robert Joseph Pierson
• Kayla Alessandria Pilato
• Christopher Angelo Pilenza

• Substance Abuse Rehabilitation Facility in Madison Heights, MI
• Providers in Madison Heights, MI by specialty
• Substance Abuse Rehabilitation Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.