Provider Demographics
NPI:1073299673
Name:LIGHT LLC
Entity Type:Organization
Organization Name:LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FITSUM
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEFERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-294-9069
Mailing Address - Street 1:13803 STROH CT
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3780
Mailing Address - Country:US
Mailing Address - Phone:571-314-7187
Mailing Address - Fax:
Practice Address - Street 1:418 MAURY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224
Practice Address - Country:US
Practice Address - Phone:571-294-9069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle