Provider Demographics
NPI:1346867041
Name:GUIDING LIGHT HOME FOR BOYS, INC.
Entity Type:Organization
Organization Name:GUIDING LIGHT HOME FOR BOYS, INC.
Other - Org Name:GUIDING LIGHT HOME FOR BOYS, INC. STRTP SITE 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-906-1424
Mailing Address - Street 1:25123 MIDDLEBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-9204
Mailing Address - Country:US
Mailing Address - Phone:951-485-0423
Mailing Address - Fax:951-485-9164
Practice Address - Street 1:25123 MIDDLEBROOK WAY
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-9204
Practice Address - Country:US
Practice Address - Phone:951-485-0423
Practice Address - Fax:951-485-9164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUIDING LIGHT HOME FOR BOYS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-29
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children