Provider Demographics
NPI:1073153664
Name:PLEASANT LIGHT LLC
Entity Type:Organization
Organization Name:PLEASANT LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSPHAT
Authorized Official - Middle Name:NYAMBATI
Authorized Official - Last Name:OMARI
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:952-406-8951
Mailing Address - Street 1:14501 GRAND AVE APT 529
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6604
Mailing Address - Country:US
Mailing Address - Phone:952-406-8951
Mailing Address - Fax:952-229-4391
Practice Address - Street 1:14501 GRAND AVE APT 529
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-6604
Practice Address - Country:US
Practice Address - Phone:952-406-8951
Practice Address - Fax:952-229-4391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health