1538448311 NPI number — LIGHT & LOVE HOME

Table of content: BRENT ADAIR MARQUETTE RN (NPI 1114150851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538448311 NPI number — LIGHT & LOVE HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIGHT & LOVE HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538448311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
812 54TH ST
Provider Second Line Business Mailing Address:
5FL
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11220-3268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-686-7798
Provider Business Mailing Address Fax Number:
718-686-7298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 54TH ST
Provider Second Line Business Practice Location Address:
5FL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220-3268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-686-7798
Provider Business Practice Location Address Fax Number:
718-686-7298
Provider Enumeration Date:
08/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HUI
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
YUK
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
718-686-7798

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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