Provider Demographics
NPI:1396766333
Name:THE LIGHT PROGRAM, INC.
Entity type:Organization
Organization Name:THE LIGHT PROGRAM, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMR HELPDESK SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SATTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-552-0229
Mailing Address - Street 1:700 AMERICAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4031
Mailing Address - Country:US
Mailing Address - Phone:814-552-0229
Mailing Address - Fax:610-981-6078
Practice Address - Street 1:1440 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1236
Practice Address - Country:US
Practice Address - Phone:814-552-0229
Practice Address - Fax:610-644-4066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
323P00000X
PA125090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7016608OtherAETNA PROVIDER NUMBER
PA0001788000OtherBCBS PROVIDER NUMBER
PA098638Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER