Healthcare Provider Details

I. General information

NPI: 1093347569
Provider Name (Legal Business Name): LIGHT ACCOMMODATION FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7322 SOUTHWEST FWY STE 1176
HOUSTON TX
77074-2118
US

IV. Provider business mailing address

14004 GINGER COVE CT
PEARLAND TX
77584-1837
US

V. Phone/Fax

Practice location:
  • Phone: 832-489-2730
  • Fax:
Mailing address:
  • Phone: 832-489-2730
  • Fax: 425-660-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DARYLWON D JERROLS
Title or Position: CEO
Credential:
Phone: 832-489-2730