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General NPI Number Information
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NPI Number | 1770852444
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Entity Type | Organization
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Legal Business Name | THE LIGHT HOUSE-GIFT OF LIFE, INC.
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Dates
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Enumeration Date | 12/23/2011
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 203 CENTENNIAL STREET SUITE 101
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City | LA PLATA
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State | MD
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Zip | 20646
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Country | US
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Telephone | 301-934-3683
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Fax | 301-934-3785
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Provider Business Mailing Address
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Address Line | PO BOX 157
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City | NEWBURG
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State | MD
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Zip | 20664-0157
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Country | US
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Telephone | 301-934-3683
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Fax | 301-934-3785
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Authorized Official
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Title or Position | FOUNDER EXECUTIVE DIRECTOR
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Name | SONJA HALL MAHONEY
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Credential |
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Telephone | 301-690-2029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | LP33111
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License Number State | MD
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