MEDICARE: GUIDING LIGHT HEALTHCARE

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1295967891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDING LIGHT HEALTHCARE

Provider Business Mailing Address
First Line	:	10640 HOLMES RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-3404
Country	:	US
Telephone Number	:	913-909-7298
Fax Number	:

Provider Business Practice Location Address
First Line	:	10640 HOLMES RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-3404
Country	:	US
Telephone Number	:	913-909-7298
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALFREDO EHICHOYA EGBADON
Credential	:
Telephone Number	:	913-909-7298

Provider Enumeration Date	:	08/14/2009
Last Update Date	:	08/14/2009

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Directions to “GUIDING LIGHT HEALTHCARE ” Practice Location

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