Provider Demographics
NPI:1609755578
Name:PRIME LIGHT HEALTH SERVICES
Entity type:Organization
Organization Name:PRIME LIGHT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKIRAT
Authorized Official - Middle Name:OLABISI
Authorized Official - Last Name:AROWOROWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-857-7475
Mailing Address - Street 1:1319 WOODBRIDGE STATION WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3852
Mailing Address - Country:US
Mailing Address - Phone:443-857-7475
Mailing Address - Fax:
Practice Address - Street 1:1319 WOODBRIDGE STATION WAY STE 101
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3852
Practice Address - Country:US
Practice Address - Phone:443-857-7475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty