1386184570 NPI number — GUIDING LIGHTS PLC

Table of content: (NPI 1386184570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386184570 NPI number — GUIDING LIGHTS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUIDING LIGHTS PLC
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:
6
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:
1386184570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1239 WOODLAND DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
ELIZABETHTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42701-2770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-900-1461
Provider Business Mailing Address Fax Number:
270-900-1468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 W LINCOLN TRAIL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RADCLIFF
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40160-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-900-1461
Provider Business Practice Location Address Fax Number:
270-900-1468
Provider Enumeration Date:
03/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MAHMOOD
Authorized Official First Name:
IJAZ
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
270-300-4461

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  31150 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64311509 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com