Provider Demographics
NPI:1962617282
Name:MORNING LIGHT, INC.
Entity type:Organization
Organization Name:MORNING LIGHT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:318-251-0580
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-0548
Mailing Address - Country:US
Mailing Address - Phone:318-251-0580
Mailing Address - Fax:318-247-5357
Practice Address - Street 1:1564 S HUDSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-4022
Practice Address - Country:US
Practice Address - Phone:318-259-8906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA159320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1718360Medicaid