Organization
LIGHT AND GLORY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALDINE RICAFORTE RN (PROGRAM DIRECTOR)
(757) 215-6953
Entity
Organization
Contact information
Practice address
1513 MALLORY CT, VIRGINIA BEACH, VA 23464-6419
(757) 215-6953
(757) 467-3604
Mailing address
1513 MALLORY CT, VIRGINIA BEACH, VA 23464-6419
(757) 215-6953
(757) 467-3604
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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