Provider Demographics
NPI:1770361065
Name:INTO THE LIGHT LLC
Entity type:Organization
Organization Name:INTO THE LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HONN
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC
Authorized Official - Phone:855-984-1788
Mailing Address - Street 1:101 E REDLANDS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4724
Mailing Address - Country:US
Mailing Address - Phone:855-984-1788
Mailing Address - Fax:
Practice Address - Street 1:101 E REDLANDS BLVD STE 275
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4721
Practice Address - Country:US
Practice Address - Phone:855-984-1788
Practice Address - Fax:909-335-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health