Provider Demographics
NPI:1104648963
Name:FIRSTLIGHT HOME CARE OF GREATER CHARLOTTE LLC
Entity type:Organization
Organization Name:FIRSTLIGHT HOME CARE OF GREATER CHARLOTTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-879-2394
Mailing Address - Street 1:219 GREENWICH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2315
Mailing Address - Country:US
Mailing Address - Phone:704-879-2394
Mailing Address - Fax:
Practice Address - Street 1:219 GREENWICH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2315
Practice Address - Country:US
Practice Address - Phone:704-879-2394
Practice Address - Fax:704-220-2381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEST FUTURE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health