Provider Demographics
NPI:1639669682
Name:LIGHT OF HOPE SUPPORTED LIVING SERVICES LLC
Entity Type:Organization
Organization Name:LIGHT OF HOPE SUPPORTED LIVING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIKA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-245-1307
Mailing Address - Street 1:7225 COLERAIN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-5329
Mailing Address - Country:US
Mailing Address - Phone:513-245-1307
Mailing Address - Fax:513-245-1317
Practice Address - Street 1:7225 COLERAIN AVE STE 204
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-5329
Practice Address - Country:US
Practice Address - Phone:513-245-1307
Practice Address - Fax:513-245-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health