1396938262 NPI number — NEW LIGHT CONSULTANTS

Table of content: (NPI 1396938262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396938262 NPI number — NEW LIGHT CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW LIGHT CONSULTANTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396938262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 359
Provider Second Line Business Mailing Address:
8511 STATE ST.
Provider Business Mailing Address City Name:
MILLINGTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48746-0359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-871-6695
Provider Business Mailing Address Fax Number:
989-871-3663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8511 STATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLINGTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48746-9446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-871-6695
Provider Business Practice Location Address Fax Number:
989-871-3663
Provider Enumeration Date:
08/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WATKINS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
O
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
989-871-6695

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 790026 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 790026 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X , with the licence number: 790026 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)