Provider Demographics
NPI:1598921314
Name:LIGHT SOURCE CAREGIVERS, LLC
Entity Type:Organization
Organization Name:LIGHT SOURCE CAREGIVERS, LLC
Other - Org Name:SYNERGY HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-663-9185
Mailing Address - Street 1:10609 N HAYDEN RD
Mailing Address - Street 2:SUITE E-110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-8512
Mailing Address - Country:US
Mailing Address - Phone:480-663-9185
Mailing Address - Fax:480-367-8015
Practice Address - Street 1:10609 N HAYDEN RD
Practice Address - Street 2:SUITE E-110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-8512
Practice Address - Country:US
Practice Address - Phone:480-663-9185
Practice Address - Fax:480-367-8015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health