Provider Demographics
NPI:1093394470
Name:PORCHLIGHT LLC
Entity Type:Organization
Organization Name:PORCHLIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:614-289-8659
Mailing Address - Street 1:891 S RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-2730
Mailing Address - Country:US
Mailing Address - Phone:937-207-7216
Mailing Address - Fax:
Practice Address - Street 1:1115 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2690
Practice Address - Country:US
Practice Address - Phone:614-289-8659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health