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General NPI Number Information
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NPI Number | 1194268573
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Entity Type | Organization
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Legal Business Name | GREATER LIGHT HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 5680 KING CENTRE DR SUITE 600
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5757
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Country | US
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Telephone | 240-222-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 TOTTEN HOLLOW PL
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City | WHITE PLAINS
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State | MD
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Zip | 20695-4452
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELVIN JONGO
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Credential |
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Telephone | 240-222-2828
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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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