Provider Demographics
NPI:1932095510
Name:LIFE AND LIGHT HEALTHCARE SERVICES
Entity type:Organization
Organization Name:LIFE AND LIGHT HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:YEWANDE
Authorized Official - Last Name:ADEWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-854-3059
Mailing Address - Street 1:6630 MOONFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1011
Mailing Address - Country:US
Mailing Address - Phone:443-854-3059
Mailing Address - Fax:443-869-2547
Practice Address - Street 1:6630 MOONFLOWER CT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1011
Practice Address - Country:US
Practice Address - Phone:443-854-3059
Practice Address - Fax:443-869-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16527063OtherCAQH
MD487259200Medicaid