Provider Demographics
NPI:1992416739
Name:AMERICAN LIGHT HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:AMERICAN LIGHT HOME CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-338-0442
Mailing Address - Street 1:4 RIVERHURST RD APT 440
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-6603
Mailing Address - Country:US
Mailing Address - Phone:775-338-0442
Mailing Address - Fax:
Practice Address - Street 1:1500 DISTRICT AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5069
Practice Address - Country:US
Practice Address - Phone:508-444-8851
Practice Address - Fax:508-657-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110191140Medicaid