Provider Demographics
NPI:1548933948
Name:LIGHT OF LIFE HEALTH AGENCY LLC
Entity type:Organization
Organization Name:LIGHT OF LIFE HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:RAYUNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-658-0362
Mailing Address - Street 1:9730 BAIRD RD APT 822
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3821
Mailing Address - Country:US
Mailing Address - Phone:318-349-0778
Mailing Address - Fax:
Practice Address - Street 1:9730 BAIRD RD APT 822
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3821
Practice Address - Country:US
Practice Address - Phone:318-349-0778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care