Organization
PERSONALIZED NURSING LIGHT HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH S PALIWODA MBA, CAC-I (CEO)
(734) 451-7800
Entity
Organization
Contact information
Practice address
575 S MAIN ST STE 6, PLYMOUTH, MI 48170-1778
(734) 451-7800
(734) 451-5410
Mailing address
575 S MAIN ST, SUITE 6, PLYMOUTH, MI 48170-1778
(734) 451-7800
(734) 451-5410
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
821032
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
821032
STATE LICENSE
MI
Enumeration date
03/09/2007
Last updated
05/07/2018
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