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General NPI Number Information
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NPI Number | 1700771862
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Entity Type | Organization
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Legal Business Name | LIGHT OF HOPE SERVICES LLC
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 154 TUSKAWILLA RD
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City | WINTER SPRINGS
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State | FL
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Zip | 32708-2825
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Country | US
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Telephone | 689-275-4964
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 160553
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-0553
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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 | CEO
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Name | BAILEY KOCHIS-EDGERTON
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Credential |
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Telephone | 689-275-4964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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