Healthcare Provider Details

I. General information

NPI: 1821635327
Provider Name (Legal Business Name): GUIDING LIGHT ASSISTED LIVING RETIREMENT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NW 109TH AVE APT 107
PEMBROKE PINES FL
33026-5116
US

IV. Provider business mailing address

125 NW 109TH AVE APT 107
PEMBROKE PINES FL
33026-5116
US

V. Phone/Fax

Practice location:
  • Phone: 561-631-2132
  • Fax: 407-369-4659
Mailing address:
  • Phone: 561-631-2132
  • Fax: 407-369-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DIANNA SIMPSON
Title or Position: OWNER
Credential:
Phone: 561-631-2132