Healthcare Provider Details

I. General information

NPI: 1073299673
Provider Name (Legal Business Name): LIGHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 MAURY ST
RICHMOND VA
23224
US

IV. Provider business mailing address

13803 STROH CT
ACCOKEEK MD
20607-3780
US

V. Phone/Fax

Practice location:
  • Phone: 571-294-9069
  • Fax:
Mailing address:
  • Phone: 571-314-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: FITSUM A TEFERA
Title or Position: OFFICER
Credential:
Phone: 703-294-9069