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General NPI Number Information
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NPI Number | 1235678681
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Entity Type | Organization
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Legal Business Name | AMERICAN LIGHT HOMECARE SERVICES
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 309 MOODY ST FL 2
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City | WALTHAM
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State | MA
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Zip | 02453-5206
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Country | US
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Telephone | 775-338-0442
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Fax | 775-210-0142
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Provider Business Mailing Address
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Address Line | 46 ELSON RD
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City | WALTHAM
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State | MA
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Zip | 02451-0715
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Country | US
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Telephone | 775-210-0142
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HENRY LUBEGA
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Credential | REGISTERED NURSE
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Telephone | 775-210-0142
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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 | RN2303312
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License Number State | MA
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