MEDICARE: LIGHT CARE ASSISTING AGENCY 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1922888163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHT CARE ASSISTING AGENCY LLC

Provider Business Mailing Address
First Line	:	16 APALACHEE ST
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-1067
Country	:	US
Telephone Number	:	404-409-4784
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 APALACHEE ST
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-1067
Country	:	US
Telephone Number	:	404-409-4784
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JOYCE NDICHU
Credential	:
Telephone Number	:	404-409-4784

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/04/2023

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