Provider Demographics
NPI:1386184570
Name:GUIDING LIGHTS PLC
Entity Type:Organization
Organization Name:GUIDING LIGHTS PLC
Other - Org Name:LINCOLN TRAIL ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IJAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-300-4461
Mailing Address - Street 1:1239 WOODLAND DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2770
Mailing Address - Country:US
Mailing Address - Phone:270-900-1461
Mailing Address - Fax:270-900-1468
Practice Address - Street 1:555 W LINCOLN TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-3301
Practice Address - Country:US
Practice Address - Phone:270-900-1461
Practice Address - Fax:270-900-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31150261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64311509Medicaid
KY64311509Medicaid
KYP400040842Medicare PIN