Provider Demographics
NPI:1821356734
Name:LIGHT JUNCTION PEDIATRICS HOME HEALTH LC
Entity Type:Organization
Organization Name:LIGHT JUNCTION PEDIATRICS HOME HEALTH LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOVITA
Authorized Official - Middle Name:LENORA
Authorized Official - Last Name:PELSUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-224-7200
Mailing Address - Street 1:4858 TORTUGA TRL
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-1228
Mailing Address - Country:US
Mailing Address - Phone:940-224-7200
Mailing Address - Fax:
Practice Address - Street 1:905 9TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3423
Practice Address - Country:US
Practice Address - Phone:940-224-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health