Healthcare Provider Details

I. General information

NPI: 1912694910
Provider Name (Legal Business Name): FRESH LIGHT PROMISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 PINEWOOD AVE
TOLEDO OH
43604-8012
US

IV. Provider business mailing address

628 PINEWOOD AVE
TOLEDO OH
43604-8012
US

V. Phone/Fax

Practice location:
  • Phone: 419-266-3676
  • Fax:
Mailing address:
  • Phone: 419-266-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. KEISHA SNOW-VELEY
Title or Position: OWNER
Credential:
Phone: 419-266-3676