Provider Demographics
NPI:1659770881
Name:FIRSTLIGHT HOME CARE
Entity Type:Organization
Organization Name:FIRSTLIGHT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-651-2273
Mailing Address - Street 1:2520 S HIGHWAY 17
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7657
Mailing Address - Country:US
Mailing Address - Phone:843-651-2273
Mailing Address - Fax:843-651-1592
Practice Address - Street 1:2520 S HIGHWAY 17
Practice Address - Street 2:SUITE 2
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7657
Practice Address - Country:US
Practice Address - Phone:843-651-2273
Practice Address - Fax:843-651-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization