Healthcare Provider Details

I. General information

NPI: 1134368244
Provider Name (Legal Business Name): HARBOR LIGHT HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 S MONROE ST SUITE A
MONROE MI
48161-2476
US

IV. Provider business mailing address

49 S MONROE ST SUITE A
MONROE MI
48161-2476
US

V. Phone/Fax

Practice location:
  • Phone: 734-568-0402
  • Fax: 888-377-9120
Mailing address:
  • Phone: 734-568-0402
  • Fax: 888-377-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4704197498
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number4704197498
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number4704197498
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4704197498
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number4704197498
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number4704197498
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number4704197498
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number4704197498
License Number StateMI

VIII. Authorized Official

Name: MR. MATT A GELSO
Title or Position: PRESIDENT
Credential:
Phone: 734-915-7245