Provider Demographics
NPI:1891680096
Name:LIGHTSHINE HOME CARE, INC.
Entity type:Organization
Organization Name:LIGHTSHINE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:DEL PUERTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-893-5624
Mailing Address - Street 1:1400 PURDUE ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2556
Mailing Address - Country:US
Mailing Address - Phone:626-893-5624
Mailing Address - Fax:626-893-5624
Practice Address - Street 1:1400 PURDUE ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-2556
Practice Address - Country:US
Practice Address - Phone:626-893-5624
Practice Address - Fax:626-893-5624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility