Provider Demographics
NPI:1538352232
Name:SUNLIGHT HOME CARE AGENCY
Entity type:Organization
Organization Name:SUNLIGHT HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER &CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HENRIETTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MUTOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:703-565-4226
Mailing Address - Street 1:7961 FLAGER CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7961 FLAGER CIR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-7437
Practice Address - Country:US
Practice Address - Phone:703-565-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-26
Last Update Date:2007-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401071283305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service