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General NPI Number Information
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NPI Number | 1073153664
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Entity Type | Organization
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Legal Business Name | PLEASANT LIGHT LLC
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 14501 GRAND AVE APT 529
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City | BURNSVILLE
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State | MN
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Zip | 55306-6604
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Country | US
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Telephone | 952-406-8951
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Fax | 952-229-4391
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Provider Business Mailing Address
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Address Line | 14501 GRAND AVE APT 529
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City | BURNSVILLE
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State | MN
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Zip | 55306-6604
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Country | US
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Telephone | 952-406-8951
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Fax | 952-229-4391
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSPHAT NYAMBATI OMARI
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Credential | REGISTERED NURSE
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Telephone | 952-406-8951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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