Provider Demographics
NPI:1629836481
Name:GUIDING LIGHT HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:GUIDING LIGHT HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYION
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-313-6431
Mailing Address - Street 1:3825 HELMKAMPF DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6540
Mailing Address - Country:US
Mailing Address - Phone:314-313-6431
Mailing Address - Fax:
Practice Address - Street 1:1155 N HIGHWAY 67 ST STE A
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4701
Practice Address - Country:US
Practice Address - Phone:314-313-6431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health