Provider Demographics
NPI:1811655095
Name:LIGHT OF HOPE MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:LIGHT OF HOPE MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:TANJDRA
Authorized Official - Middle Name:LASANDRA
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:708-735-3405
Mailing Address - Street 1:16401 PLYMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:MARKHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60428-4738
Mailing Address - Country:US
Mailing Address - Phone:708-735-3405
Mailing Address - Fax:
Practice Address - Street 1:16401 PLYMOUTH DR
Practice Address - Street 2:
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428-4738
Practice Address - Country:US
Practice Address - Phone:708-735-3405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management