Provider Demographics
NPI:1770852444
Name:THE LIGHT HOUSE-GIFT OF LIFE, INC.
Entity Type:Organization
Organization Name:THE LIGHT HOUSE-GIFT OF LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-690-2029
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20664-0157
Mailing Address - Country:US
Mailing Address - Phone:301-934-3683
Mailing Address - Fax:301-934-3785
Practice Address - Street 1:203 CENTENNIAL STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-934-3683
Practice Address - Fax:301-934-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP33111253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care