Provider Demographics
NPI:1972911394
Name:LIGHT SOUTH WINDS, INC
Entity type:Organization
Organization Name:LIGHT SOUTH WINDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-636-6733
Mailing Address - Street 1:75 EXECUTIVE DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-8137
Mailing Address - Country:US
Mailing Address - Phone:630-636-6733
Mailing Address - Fax:630-636-6487
Practice Address - Street 1:75 EXECUTIVE DR
Practice Address - Street 2:SUITE 114
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8137
Practice Address - Country:US
Practice Address - Phone:630-636-6733
Practice Address - Fax:630-636-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3001112253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care