Provider Demographics
NPI:1790513893
Name:THE LIGHT PROGRAM, INC.
Entity type:Organization
Organization Name:THE LIGHT PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-6464
Mailing Address - Street 1:700 AMERICAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4031
Mailing Address - Country:US
Mailing Address - Phone:814-940-0407
Mailing Address - Fax:
Practice Address - Street 1:272 HAMLIN HWY
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-7415
Practice Address - Country:US
Practice Address - Phone:814-940-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LIGHT PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility