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General NPI Number Information
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NPI Number | 1396766333
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Entity Type | Organization
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Legal Business Name | THE LIGHT PROGRAM, INC.
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1440 RUSSELL RD
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City | PAOLI
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State | PA
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Zip | 19301-1236
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Country | US
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Telephone | 814-552-0229
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Fax | 610-644-4066
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Provider Business Mailing Address
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Address Line | 700 AMERICAN AVE STE 201
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-4031
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Country | US
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Telephone | 814-552-0229
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Fax | 610-981-6078
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Authorized Official
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Title or Position | EMR HELPDESK SUPERVISOR
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Name | DEBBIE SATTLER
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Credential |
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Telephone | 814-552-0229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 125090
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License Number State | PA
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