Healthcare Provider Details

I. General information

NPI: 1093517153
Provider Name (Legal Business Name): KORTUE LIGHT HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 RICHARDS AVE
LANSDOWNE PA
19050-1816
US

IV. Provider business mailing address

283 RICHARDS AVE
LANSDOWNE PA
19050-1816
US

V. Phone/Fax

Practice location:
  • Phone: 267-972-2404
  • Fax:
Mailing address:
  • Phone: 267-972-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PEACHES MULBAH
Title or Position: CEO
Credential:
Phone: 267-972-2404