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General NPI Number Information
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NPI Number | 1952803645
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Entity Type | Individual
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Provider Name | MR. RONNELL MARKETTE LIGHTFOOT
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Gender | Male
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Dates
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Enumeration Date | 03/08/2018
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 2231 MERLE ST
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City | HENRICO
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State | VA
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Zip | 23231-1965
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Country | US
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Telephone | 804-497-0098
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Fax |
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Provider Business Mailing Address
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Address Line | 2231 MERLE ST
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City | HENRICO
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State | VA
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Zip | 23231-1965
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Country | US
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Telephone | 804-497-0098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 385H00000X
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Taxonomy Name | Respite Care
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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