Provider Demographics
NPI:1639956972
Name:NEW VISION WELLNESS CENTER LLC
Entity type:Organization
Organization Name:NEW VISION WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HONORINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NJITA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,FNP-BC
Authorized Official - Phone:313-529-1267
Mailing Address - Street 1:44777 SALTZ RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2982
Mailing Address - Country:US
Mailing Address - Phone:313-529-1267
Mailing Address - Fax:
Practice Address - Street 1:44777 SALTZ RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2982
Practice Address - Country:US
Practice Address - Phone:313-529-1267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty