Healthcare Provider Details

I. General information

NPI: 1255165155
Provider Name (Legal Business Name): 1ST LIGHT OF LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7477 COMMONS BLVD APT 1127
CHATTANOOGA TN
37421-2362
US

IV. Provider business mailing address

7477 COMMONS BLVD APT 1127
CHATTANOOGA TN
37421-2362
US

V. Phone/Fax

Practice location:
  • Phone: 423-364-3319
  • Fax:
Mailing address:
  • Phone: 423-364-3319
  • 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KORTNEA YOUNG
Title or Position: OWNER
Credential:
Phone: 423-364-3319