Healthcare Provider Details

I. General information

NPI: 1730799271
Provider Name (Legal Business Name): THE URBAN LIGHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 STRONG ST
MANCHESTER CT
06042-3110
US

IV. Provider business mailing address

46 STRONG ST
MANCHESTER CT
06042-3110
US

V. Phone/Fax

Practice location:
  • Phone: 860-994-3131
  • Fax:
Mailing address:
  • Phone: 860-994-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ERICA C KING
Title or Position: OWNER
Credential: M.ED
Phone: 860-994-3131