Provider Demographics
NPI:1558625806
Name:RAYJAY2011 LLC
Entity Type:Organization
Organization Name:RAYJAY2011 LLC
Other - Org Name:FIRSTLIGHT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-221-8733
Mailing Address - Street 1:1740 W KATELLA AVE STE M
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3434
Mailing Address - Country:US
Mailing Address - Phone:714-221-8733
Mailing Address - Fax:714-289-8010
Practice Address - Street 1:1740 W KATELLA AVE STE M
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-3434
Practice Address - Country:US
Practice Address - Phone:714-221-8733
Practice Address - Fax:714-289-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA158811253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care