Healthcare Provider Details

I. General information

NPI: 1881508182
Provider Name (Legal Business Name): LIGHT OF GLORY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 90TH ST
WEST DES MOINES IA
50266-3306
US

IV. Provider business mailing address

1040 90TH ST
WEST DES MOINES IA
50266-3306
US

V. Phone/Fax

Practice location:
  • Phone: 515-552-9089
  • Fax:
Mailing address:
  • Phone: 515-552-9089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIEL MORRIS DEISRAEL
Title or Position: CO-OWNER
Credential:
Phone: 515-552-9089