Provider Demographics
NPI:1720832843
Name:LIGHT AND LIFE HOME CARE LLC
Entity Type:Organization
Organization Name:LIGHT AND LIFE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:LUALHATI
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-544-4180
Mailing Address - Street 1:362 LUM AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7515
Mailing Address - Country:US
Mailing Address - Phone:917-544-4180
Mailing Address - Fax:
Practice Address - Street 1:362 LUM AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7515
Practice Address - Country:US
Practice Address - Phone:917-544-4180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health