Provider Demographics
NPI:1790423580
Name:THE LIGHT FOR SENIORS, INC.
Entity Type:Organization
Organization Name:THE LIGHT FOR SENIORS, INC.
Other - Org Name:LIGHT SOURCE INSURANCE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSTA-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-751-0752
Mailing Address - Street 1:8250 VICKERS ST STE G
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2117
Mailing Address - Country:US
Mailing Address - Phone:858-751-0752
Mailing Address - Fax:888-308-9223
Practice Address - Street 1:8250 VICKERS ST STE G
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2117
Practice Address - Country:US
Practice Address - Phone:858-751-0752
Practice Address - Fax:888-308-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790423580Medicaid