Provider Demographics
NPI:1780227942
Name:ADD LIGHT HOME CARE LLC
Entity Type:Organization
Organization Name:ADD LIGHT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-522-3724
Mailing Address - Street 1:586 INDIGO BAY CIR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3684
Mailing Address - Country:US
Mailing Address - Phone:732-522-3724
Mailing Address - Fax:
Practice Address - Street 1:698-S BULTMAN DR
Practice Address - Street 2:SUITE C-8
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-406-1508
Practice Address - Fax:803-406-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care