Provider Demographics
NPI:1114399243
Name:GUARDIANLIGHT OF NORTHWESTERN VA INCORPORATED
Entity Type:Organization
Organization Name:GUARDIANLIGHT OF NORTHWESTERN VA INCORPORATED
Other - Org Name:FIRSTLIGHT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:GHANBARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-931-3188
Mailing Address - Street 1:3343 VALLEY AVE
Mailing Address - Street 2:UNIT#700
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602
Mailing Address - Country:US
Mailing Address - Phone:540-431-2933
Mailing Address - Fax:540-773-4342
Practice Address - Street 1:3343 VALLEY AVE
Practice Address - Street 2:UNIT # 700
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602
Practice Address - Country:US
Practice Address - Phone:540-431-2933
Practice Address - Fax:540-773-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-161021251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health