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General NPI Number Information
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NPI Number | 1770431470
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Entity Type | Organization
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Legal Business Name | NIMOS LIGHT LLC
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 1940 RICHMOND AVE
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City | WOODBRIDGE
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State | VA
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Zip | 22191-2446
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Country | US
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Telephone | 571-516-0890
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 RICHMOND AVE
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City | WOODBRIDGE
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State | VA
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Zip | 22191-2446
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Country | US
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Telephone | 571-516-0890
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ENOCH ASANTE
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Credential | RPH
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Telephone | 571-224-7103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State |
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