1578592614 NPI number — THE LIGHT HOME CARE, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578592614 NPI number — THE LIGHT HOME CARE, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LIGHT HOME CARE, LLC.
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:
INDEPENDENCE HOME HEALTH OF MIAMI DADE
Provider Other Organization Name Type Code:
3
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:
1578592614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7270 NW 12TH ST
Provider Second Line Business Mailing Address:
TOWER II, SUITE 800
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-7018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-221-6494
Provider Business Mailing Address Fax Number:
305-221-5257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7270 NW 12TH ST
Provider Second Line Business Practice Location Address:
TOWER II, SUITE 800
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33126-7018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-221-6494
Provider Business Practice Location Address Fax Number:
305-221-5257
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
561-827-6353

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA21834096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10-9054 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 117145200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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