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General NPI Number Information
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NPI Number | 1912523879
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Entity Type | Organization
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Legal Business Name | YOUR LIGHT RESIDENTIAL CARE LLC
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 2640 ALBION AVE
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City | ORLANDO
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State | FL
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Zip | 32833-4342
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Country | US
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Telephone | 330-704-5903
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Fax |
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Provider Business Mailing Address
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Address Line | 20926 NETTLETON ST
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City | ORLANDO
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State | FL
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Zip | 32833-4362
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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 | OWNER
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Name | SHARDAE COMPTON
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Credential |
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Telephone | 330-415-2708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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