Healthcare Provider Details

I. General information

NPI: 1215381223
Provider Name (Legal Business Name): LIGHT OF THE WORLD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 MAIN ST
FORT MORGAN CO
80701-2032
US

IV. Provider business mailing address

PO BOX 481
FORT MORGAN CO
80701-0481
US

V. Phone/Fax

Practice location:
  • Phone: 970-370-2342
  • Fax: 970-370-2439
Mailing address:
  • Phone: 970-370-2342
  • Fax: 970-370-2439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number04I155
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number04I155
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number04I155
License Number StateCO

VIII. Authorized Official

Name: ROSITA FLORES
Title or Position: DIRECTOR
Credential:
Phone: 970-370-2342