Healthcare Provider Details

I. General information

NPI: 1083166268
Provider Name (Legal Business Name): GUIDING LIGHT FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22482 SW 56TH AVE
BOCA RATON FL
33433-4604
US

IV. Provider business mailing address

22482 SW 56TH AVE
BOCA RATON FL
33433-4604
US

V. Phone/Fax

Practice location:
  • Phone: 561-843-1982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FLORE DIE
Title or Position: PRESIDENT
Credential:
Phone: 561-843-1982