Healthcare Provider Details

I. General information

NPI: 1336286905
Provider Name (Legal Business Name): GUIDING LIGHT HOME HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S KING ST
WINDSOR NC
27983-6723
US

IV. Provider business mailing address

507 S KING ST
WINDSOR NC
27983-6723
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-5777
  • Fax: 252-794-3737
Mailing address:
  • Phone: 252-794-5777
  • Fax: 252-794-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3200
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2790
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3408120
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier6601143
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier6601525
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MS. RUTH ANNA JOHNSON
Title or Position: CEO
Credential:
Phone: 252-794-5777