Provider Demographics
NPI:1194268573
Name:GREATER LIGHT HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:GREATER LIGHT HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-222-2828
Mailing Address - Street 1:3300 TOTTEN HOLLOW PL
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-4452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5680 KING CENTRE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5757
Practice Address - Country:US
Practice Address - Phone:240-222-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health