Healthcare Provider Details

I. General information

NPI: 1396766333
Provider Name (Legal Business Name): THE LIGHT PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 RUSSELL RD
PAOLI PA
19301-1236
US

IV. Provider business mailing address

700 AMERICAN AVE STE 201
KING OF PRUSSIA PA
19406-4031
US

V. Phone/Fax

Practice location:
  • Phone: 814-552-0229
  • Fax: 610-644-4066
Mailing address:
  • Phone: 814-552-0229
  • Fax: 610-981-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number125090
License Number StatePA

VIII. Authorized Official

Name: DEBBIE SATTLER
Title or Position: EMR HELPDESK SUPERVISOR
Credential:
Phone: 814-552-0229