| New Light Adult Day Program Llc | |
|
25619 Southwood Dr Southfield MI 48075-2063 | |
| (248) 739-1521 | |
| Not Available |
| Full Name | New Light Adult Day Program Llc |
|---|---|
| Speciality | Social Worker |
| Location | 25619 Southwood Dr, Southfield, Michigan |
| Authorized Official Name and Position | Dion Love (OWNER) |
| Authorized Official Contact | 3132148335 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Light Adult Day Program Llc 19677 Revere St Detroit MI 48234-1711 Ph: () - | New Light Adult Day Program Llc 25619 Southwood Dr Southfield MI 48075-2063 Ph: (248) 739-1521 |
| NPI Number | 1952644676 |
|---|---|
| Provider Enumeration Date | 04/01/2013 |
| Last Update Date | 10/23/2023 |
| Certification Date | 10/23/2023 |
| Medicare PECOS PAC ID | 3870736895 |
|---|---|
| Medicare Enrollment ID | O20130823000456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952644676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Servilla V Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295867174 PECOS PAC ID: 8729040944 Enrollment ID: I20041101000059 |
| Provider Name | Gloria Love |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063865830 PECOS PAC ID: 8123261146 Enrollment ID: I20240822003337 |
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