Provider Demographics
NPI:1689112104
Name:GUIDING LIGHT ASSISTED LIVING
Entity Type:Organization
Organization Name:GUIDING LIGHT ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-410-2081
Mailing Address - Street 1:1114 CAMBRIAN PARK CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5321
Mailing Address - Country:US
Mailing Address - Phone:281-410-2081
Mailing Address - Fax:
Practice Address - Street 1:1114 CAMBRIAN PARK CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5321
Practice Address - Country:US
Practice Address - Phone:281-410-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility