| New Moon Rising Llc | |
|
2535 E Mount Hope Ave Lansing MI 48910-1913 | |
| (517) 477-0077 | |
| Not Available |
| Full Name | New Moon Rising Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2535 E Mount Hope Ave, Lansing, Michigan |
| Authorized Official Name and Position | Kaytie Ochenkowski (SOLE MEMBER) |
| Authorized Official Contact | 5174770077 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Moon Rising Llc 2535 E Mount Hope Ave Lansing MI 48910-1913 Ph: (517) 477-0077 | New Moon Rising Llc 2535 E Mount Hope Ave Lansing MI 48910-1913 Ph: (517) 477-0077 |
| NPI Number | 1265147318 |
|---|---|
| Provider Enumeration Date | 01/23/2023 |
| Last Update Date | 01/23/2023 |
| Certification Date | 01/23/2023 |
| Medicare PECOS PAC ID | 8022481373 |
|---|---|
| Medicare Enrollment ID | O20230307001908 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265147318 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kaytie L Ochenkowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073918918 PECOS PAC ID: 5698049500 Enrollment ID: I20170915001682 |
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