Healthcare Provider Details

I. General information

NPI: 1467196980
Provider Name (Legal Business Name): A GUIDING LIGHT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S ALMA SCHOOL RD STE 10950
MESA AZ
85210-2103
US

IV. Provider business mailing address

1201 S ALMA SCHOOL RD STE 10950
MESA AZ
85210-2103
US

V. Phone/Fax

Practice location:
  • Phone: 928-961-4499
  • Fax:
Mailing address:
  • Phone: 928-961-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JACOB DECINO
Title or Position: CEO
Credential:
Phone: 928-961-4499