Provider Demographics
NPI:1164174637
Name:FIRST LIGHT HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:FIRST LIGHT HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:NONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-348-8459
Mailing Address - Street 1:9550 WARNER AVE STE 250-07
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9550 WARNER AVE STE 250-07
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2800
Practice Address - Country:US
Practice Address - Phone:714-348-8459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC4828268OtherARTICLES OF INCORPORATION