MEDICARE: TRUE LIGHT SUPPORT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1235098153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE LIGHT SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	6803 GABLES WAY
Second Line	:
City	:	JOHNSTON
State	:	IA
Zip	:	50131-3026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6803 GABLES WAY
Second Line	:
City	:	JOHNSTON
State	:	IA
Zip	:	50131-3026
Country	:	US
Telephone Number	:	616-323-5958
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LYNA KANEZA KARE
Credential	:
Telephone Number	:	616-323-5958

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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