MEDICARE: LIGHTING THE PATH, 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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1275221764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTING THE PATH, LLC

Provider Business Mailing Address
First Line	:	9009 PEMBERTON ST
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-5550
Country	:	US
Telephone Number	:	352-942-8353
Fax Number	:

Provider Business Practice Location Address
First Line	:	9009 PEMBERTON ST
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34608-5550
Country	:	US
Telephone Number	:	352-942-8353
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	REBECCA LEE FAYARD
Credential	:
Telephone Number	:	352-942-8353

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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