Healthcare Provider Details

I. General information

NPI: 1336076017
Provider Name (Legal Business Name): GUIDELIGHT HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 W PEORIA AVE STE 118
PHOENIX AZ
85029-3950
US

IV. Provider business mailing address

101 FEDERAL ST STE 1900
BOSTON MA
02110-1861
US

V. Phone/Fax

Practice location:
  • Phone: 508-761-0903
  • Fax:
Mailing address:
  • Phone: 508-761-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHARLES SPOSATO
Title or Position: CAO
Credential:
Phone: 202-415-8497