Provider Demographics
NPI:1720025224
Name:APPLIED LIGHTING INC
Entity Type:Organization
Organization Name:APPLIED LIGHTING INC
Other - Org Name:THE PINK DOOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DETAR
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:386-328-9424
Mailing Address - Street 1:101 SUNSET PT
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-9018
Mailing Address - Country:US
Mailing Address - Phone:386-328-9424
Mailing Address - Fax:386-328-9470
Practice Address - Street 1:101 SUNSET PT
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-9018
Practice Address - Country:US
Practice Address - Phone:386-328-9424
Practice Address - Fax:386-328-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2732OtherBLUE CROSS BLUE SHIELD
FL5535640001Medicare NSC