Provider Demographics
NPI:1821847427
Name:LIGHT & ROD LLC
Entity type:Organization
Organization Name:LIGHT & ROD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:CHELSEA
Authorized Official - Last Name:SISOUNONG
Authorized Official - Suffix:
Authorized Official - Credentials:MA BCBA, LBA
Authorized Official - Phone:860-578-0832
Mailing Address - Street 1:999 PEPPERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:999 PEPPERWOOD DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-9387
Practice Address - Country:US
Practice Address - Phone:860-578-0832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care