Provider Demographics
NPI:1134368244
Name:HARBOR LIGHT HEALTH INC.
Entity type:Organization
Organization Name:HARBOR LIGHT HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GELSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-915-7245
Mailing Address - Street 1:49 S MONROE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2476
Mailing Address - Country:US
Mailing Address - Phone:734-568-0402
Mailing Address - Fax:888-377-9120
Practice Address - Street 1:49 S MONROE ST
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2476
Practice Address - Country:US
Practice Address - Phone:734-568-0402
Practice Address - Fax:888-377-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704197498251F00000X, 251G00000X, 251J00000X, 253Z00000X, 302R00000X, 305R00000X, 385H00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No385H00000XRespite Care FacilityRespite Care