Healthcare Provider Details

I. General information

NPI: 1437723053
Provider Name (Legal Business Name): LIGHT WITHIN HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 S 228TH PL
KENT WA
98031-2559
US

IV. Provider business mailing address

9921 S 228TH PL
KENT WA
98031-2559
US

V. Phone/Fax

Practice location:
  • Phone: 206-861-3232
  • Fax:
Mailing address:
  • Phone: 612-978-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HODAN FARAH RAGE
Title or Position: DIRECTOR
Credential: BSN, RN
Phone: 206-861-3232