Provider Demographics
NPI:1518677293
Name:LIGHT HOPE CARE LLC
Entity Type:Organization
Organization Name:LIGHT HOPE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RWIRANGIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-999-7430
Mailing Address - Street 1:326 AUBURN ST APT 24
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6019
Mailing Address - Country:US
Mailing Address - Phone:904-699-2509
Mailing Address - Fax:
Practice Address - Street 1:326 AUBURN ST APT 24
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6019
Practice Address - Country:US
Practice Address - Phone:904-699-2509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities