Provider Demographics
NPI:1336286905
Name:GUIDING LIGHT HOME HEALTH, INC
Entity Type:Organization
Organization Name:GUIDING LIGHT HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-794-5777
Mailing Address - Street 1:507 S KING ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-6723
Mailing Address - Country:US
Mailing Address - Phone:252-794-5777
Mailing Address - Fax:252-794-3737
Practice Address - Street 1:507 S KING ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-6723
Practice Address - Country:US
Practice Address - Phone:252-794-5777
Practice Address - Fax:252-794-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2790251E00000X
NCHC3200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408120Medicaid
NC6601143Medicaid
NC6601525Medicaid