Provider Demographics
NPI:1740068410
Name:ABIDING LIGHT HOMECARE
Entity type:Organization
Organization Name:ABIDING LIGHT HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, COTA
Authorized Official - Phone:512-850-6818
Mailing Address - Street 1:16225 PARK TEN PL STE 500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5152
Mailing Address - Country:US
Mailing Address - Phone:512-850-6818
Mailing Address - Fax:
Practice Address - Street 1:16225 PARK TEN PL STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5152
Practice Address - Country:US
Practice Address - Phone:512-850-6818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care