Provider Demographics
NPI:1518990985
Name:LAMB'S LIGHT HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:LAMB'S LIGHT HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIILU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-581-0900
Mailing Address - Street 1:9045 HAVEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5427
Mailing Address - Country:US
Mailing Address - Phone:909-581-0900
Mailing Address - Fax:909-581-1833
Practice Address - Street 1:9045 HAVEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5427
Practice Address - Country:US
Practice Address - Phone:909-581-0900
Practice Address - Fax:909-581-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA037880OtherBUSINESS LICENSE NO.
CAHJ0270-854OtherIRC VENDOR NO.
CAHHA08147FMedicaid
CA037880OtherBUSINESS LICENSE NO.