Provider Demographics
NPI:1780033522
Name:THE LIGHT TIME GIFT HEALTH CARE
Entity Type:Organization
Organization Name:THE LIGHT TIME GIFT HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UNUAGBON
Authorized Official - Middle Name:QUEENSLEY
Authorized Official - Last Name:TOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-876-1065
Mailing Address - Street 1:140 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3114
Practice Address - Country:US
Practice Address - Phone:978-876-1065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001220301251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health