Provider Demographics
NPI:1952515652
Name:LIGHT OF HOPE AGENCY
Entity Type:Organization
Organization Name:LIGHT OF HOPE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIETTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUBIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:916-723-8773
Mailing Address - Street 1:8084 OLD AUBURN RD
Mailing Address - Street 2:SUITE C.
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-2559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8084 OLD AUBURN RD
Practice Address - Street 2:SUITE C.
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2559
Practice Address - Country:US
Practice Address - Phone:916-225-3726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 18904251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033282488Medicare UPIN