Provider Demographics
NPI:1962886499
Name:AMAZING LIGHT HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:AMAZING LIGHT HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:TINA
Authorized Official - Last Name:NWOKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-949-9777
Mailing Address - Street 1:105 SWITCHBACK ST
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6004
Mailing Address - Country:US
Mailing Address - Phone:919-949-9777
Mailing Address - Fax:
Practice Address - Street 1:3515 MAITLAND DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1239
Practice Address - Country:US
Practice Address - Phone:919-949-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 253Z00000X
NCHC4784385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care