Healthcare Provider Details

I. General information

NPI: 1912498783
Provider Name (Legal Business Name): RAYS OF LIGHT COMPANION CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2018
Last Update Date: 05/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 FOREST AVE # 2G
GLEN COVE NY
11542
US

IV. Provider business mailing address

70 FOREST AVE # 2G
GLEN COVE NY
11542-2117
US

V. Phone/Fax

Practice location:
  • Phone: 516-373-5586
  • Fax:
Mailing address:
  • Phone: 516-373-5586
  • Fax:

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 Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: YVELISE MARCELLUS
Title or Position: OWNER
Credential:
Phone: 516-373-5586