Provider Demographics
NPI:1811039720
Name:GUIDING LIGHT INC
Entity type:Organization
Organization Name:GUIDING LIGHT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELVIN
Authorized Official - Middle Name:AUNDRA
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-361-1999
Mailing Address - Street 1:PO BOX 42308
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-0006
Mailing Address - Country:US
Mailing Address - Phone:704-361-1999
Mailing Address - Fax:704-409-4877
Practice Address - Street 1:1205 N PINE ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-4711
Practice Address - Country:US
Practice Address - Phone:910-738-4095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301608GMedicaid
NC8301608BMedicaid
NC8301608Medicaid