Provider Demographics
NPI:1538843487
Name:THE LIGHT RECOVERY AND WELLNESS LLC
Entity type:Organization
Organization Name:THE LIGHT RECOVERY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:DAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-583-6835
Mailing Address - Street 1:2538 E UNIVERSITY DR STE 280
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-6947
Mailing Address - Country:US
Mailing Address - Phone:602-354-7514
Mailing Address - Fax:602-354-7519
Practice Address - Street 1:2538 E UNIVERSITY DR STE 280
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-6947
Practice Address - Country:US
Practice Address - Phone:602-354-7514
Practice Address - Fax:602-354-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health